
Ojungsangla Longkumer
The Context
“Now, tell me about the place where you come from? I am from Nagaland, a Tribal State in the North Eastern part of India. Nagaland is a place rich in vibrant cultural diversity, flora and fauna and also the place where we celebrate the famous Hornbill festival. You will also see that Nagas live in a society where there is strong community involvement in the local governance and policies to strengthen and execute development activities. We are blessed to live in a community-oriented society”. Recalling the encounters of how I would often introduce my home place to the group each time I am in the company of a diverse community. My vast Public Health exposures in many parts of India often left me pondering, comparing and understanding the importance of community taking ownership of their own health care institutions remarkably shaping the health care needs as compared to those places where there was poor or negligible hands-on from the community. And the wonderful opportunity of grabbing this essay writing by “The Kevichusa Foundation” has opened a massive platform for me to share, advocate and reinforce on one of the greatest potentials we have as Nagas in Nagaland “The power of Communitization”.
State Health System Status
Access to essential healthcare services is a basic right and need for human. Ensuring everyone has access to quality health care services that is affordable and effective to promote well-being and healthy lives is one of the United Nations’ Sustainable Development Goal. Looking at the status of health care services in our State, it is complex faced by both challenges and issues to deliver improved healthcare services. We have public health facilities that are far better equipped to provide services while on the other side there is larger proportion of the facilities in dilapidated conditions. Patients and families travelling to other neighbouring States to avail treatment facilities incurring catastrophic expenditures is a common story every household has to narrate. In the recent years, tremendous efforts have been initiated to improve the healthcare services and infrastructure to provide better services to the community. However, we still have a long and arduous journey ahead to ensure resilient health care facilities to provide essentials services.
Quality Health Facilities
The bigger picture talk of the day for establishing better health care facilities is the Country wide momentum drive of NQAS (National Quality Assurance Standards) certified health facilities established by the Government of India with effect from 2013. NQAS program, a Quality Assurance initiative to ensure specific requirements for public health facilities as well at par with global best practices. NQAS certified hospitals demonstrate a commitment to quality healthcare delivery and patient safety and satisfaction. Quality is the need of the hour in health care institutes for provision of services. The big divide with other States that has achieved a large number of NQAS certified facilities is that Nagaland as of 31st October, 2024, has 7 public health facilities as quality certified under NQAS and a handful in preparation for certification. This barely covers a little less than 1% (approx. 790) of the total public health facilities in the State. And the pertinent question, “how will the State ensure availability of better health facilities for the people? The Citizens cries out for need of a better resilient health care system.” It places a huge responsibility and effort on the State to make this happen. But what lies beyond, is what we shall dwell in the following paragraphs in the best interest of all.
What we have? Communitization
As far as concerned, with the enactment of Nagaland Communitization of Public Institutions and Services Act, 2002, communitization was launched in the Health Department as well. The programme was launched as part of innovative governance by the State to actively engage and harness the community effective development activities. Nagaland has set a greater example and has been recognized at National and International level for the best practices of Communitization. Initially the focus was only in the rural based health centres, but in due course of time, almost all the functioning health units have been communitized. The State has witnessed wonderful results in the health system change particularly where communitization has taken an upper hand. Transformation of barely standing health units to creation of beautiful structures with essentials services to the community had led to better utilization of services and a happy and content community. What more can the community ask for when they can avail treatment facilities at an affordable cost and within their convenience?
A Time to Understand Communitization in Health
With the programme initiative, community has been sensitized to work along in partnership and sharing responsibilities in the planning, management and implementation of public institutions and services. Active involvement of the community has led to better immunization coverage, health seeking behaviours, timely care, reduction in morbidity and mortality etc. The existing Health Center Management Committee (HCMC) also named as Jan Arogya Samiti (JAS) has been constituted in all the public health facilities that include Primary Health Centers (PHC), Community Health Centers (CHC), and Sub Centers Health and Wellness Centers (SC HWC) respectively. The committee performs the functions transferred from the Government such as assets, powers and managerial functions. Health facilities where community has taken responsibility and ownership has better mobilization of contributions / resource and utilization of services. This is very evident as demonstrated by the 7 NQAS certified health units, where Community has played a major role to strengthen the facility as per the set standards and criterias. Thus, leading to Quality certified facilities. Of course, it requires an endless multi-disciplinary and team effort from all section of health to achieve this requirement.
Who wouldn’t want a good hospital?
One afternoon, I had a casual conversation with a friend who strongly opined that “the primary welfare of the State should focus on education, provision of safe drinking water and good road connectivity and the rest will follow.” And to which I quickly added, “we also need good public hospitals.” Yes! We need good hospitals, from where we can avail treatment at minimal cost without having to travel far. Also, to minimize overwhelming health care expenditures for all economic section of people. And the time where we can completely trust in the quality of our hospitals and having patient satisfaction level on the highest scale. And the effort of the health care workers is recognized and given due credit for their tireless effort. And the health care sector can be one of the most sought-after job placements. How wonderful to envision Nagaland with such scenic hospital landscape too.
Complete Ownership
A call on to the community to make our health care facilities a better equipped to provide basic essential and emergency services. To understand that the village Sub Center or Primary Health Center or Community Health Center are the villagers’ own property and they need to take responsibility to make it function well. And You and I are the community, and together we need to take complete ownership of the healthcare system. Our every little endowment in any form, I believe will create a massive impact and motivate our fellow members. We can be the change agent and witness the trajectory transformation.
Health Literacy
Health promotion activities are ongoing and a routine task by health care workers and volunteers. We need to continue addressing the health literacy among all groups of community and ensure they understand how to prevent and manage health conditions. Foster community ownership of health issues by local involvement in health monitoring, reporting, and advocacy, so that the community feels responsible for improving and maintaining its own health standards. This can lead to better health seeking behaviour and also aid the health care workers to relieve the burden of preventive aspects of care.
Health Committee
Village Health Committee or Health Center Managing Committee as constituted and present in all the health units play pivotal role. The current crucial issue is the existing human resources shortage that puts huge strain and stress in delivering services. The community should demand for appropriate HR wherever health center is available. For a community to maintain good health and function effectively, we need functional health facility and not an idle or ghost health facility. The second issue is lack of adequate infrastructure and equipment. How can the treating Physician proceed without basic diagnostic equipment? There is a need for regular mobilization of resources from individuals, organizations and societies in the best possible way.
Leadership
Volunteerism and local leaders from various societies, organizations can help build bonds, contribute to a sense of belonging. Nagaland fosters a countless number of societies, associations, organization including faith based and churches. This is a boon to the society and we can identify and nurture volunteers and leaders so they can motivate and inspire others. Take the issue of health as a common cause to advocate for in all relevant platforms.
Technology Driven
Leverage technology and innovation in today’s 5G era. There are numerous existing technology-mobile based applications and features to promote health, recording and reporting etc. Now, in what ways can community make the best effort of technology to communitize the issues and wants? Social media content creators and influencers can be utilized to deliberate on how to use the media platform effectively to buy in people for strengthening the health care system. Their involvement will have a wide and fast impact to the larger community.
Explore CSR
Can we bring in more Corporate Social Responsibility projects to work in the health sectors? This responsibility vests in the authorities, policies reformers and public leaders. CSR projects have shown results delivered efficiently in a short time frame. The possibility, feasibility and potential of CSR funded projects will be beneficial particularly in infrastructural development and equipment availability. It would be a win-win activity.
Saturate Quality Certified Facilities
Nagaland has 17 districts, each district caters to all categories of health care facilities. There is overt disparity in the health care status and needs across which need to be addressed. With the massive quality certification drive, it would be a great opportunity for all sectors, sections, individuals and groups to join hand together to strive for atleast a handful of quality certified facilities available in each district. And create a Model health care facility in all the districts. Nagaland will have a beautiful health care delivery system and an increase in the pool of the services utilization.
Recognition and Award Mechanism
Dwelling on the past practices of awarding best health facility under communization program was a great initiative and beneficial to recognize the efforts of the participation. This boosts the morale and motivates each and everyone. Such measures should continue and widely acknowledge using larger social media platforms and events.
Conclusion
As a Naga, I proudly portray the rich community driven society that I belong to and live in. We are fortunate and blessed to have such strong community led practices and we make the best use of this blessing by harnessing the greatest potentials of Nagaland in the form of communitization. Ultimately, good hospitals are not just a State Government responsibility nor the concerned department alone. But it is everyone’s duty and shared responsibility to make health care facilities our own. By working together and using the strong bond of our community, we can lead a massive health care reformation and transformation and have an accessible, affordable and quality public health care facilities in our State.
Winner of the Chalie Kevichusa Essay Competition 2024 on the theme “Potentials of Nagaland” (Senior Category)