Where care is not a right but a privilege: Nagaland's bleak healthcare system

Vizokhole Ltu
Senior Research Associate, NESRC

“Every morning, scores of families depart not for leisure or commerce, but on a pilgrimage of survival, bound for Vellore, Guwahati, Delhi, or Mumbai. We have normalised a culture where the diagnosis of a critical illness is immediately followed by the assumption of travel. In this context, the ‘referral patient’ has become a tragic archetype of our society: a citizen whom the state has officially acknowledged it cannot save” (Kamei, 2025). The passage vividly highlights the grim reality faced by many families in Nagaland when confronted with critical illness. It depicts how, rather than seeking leisure or routine activities, families are compelled to embark on long and arduous journeys to major cities like Vellore, Guwahati, Delhi, or Mumbai in their quest for survival. In fact, Nagaland has a high rate of cancer patients seeking treatment outside the state, with 58.1% doing so (ICMR-NCDIR, 2021). 

The statistic that 58.1% of cancer patients from Nagaland seek treatment outside the state underscores the lack of adequate healthcare facilities. The term “referral patient” has thus become a tragic symbol of systemic failure, representing individuals whom the state has acknowledged it cannot save. The inadequacies of local healthcare facilities and the broader neglect of accessible medical infrastructure are forcing families into desperate journeys that have often become acts of last resort. More importantly, this bleak reality is accessible only to a privileged few, while the majority of the population is left to face their desperate circumstances alone, unable to afford such costly journeys and treatments. Ultimately, it exposes a society where healthcare is not a right but a privilege, and where the inability of the system to provide timely, quality care transforms patients into tragic archetypes of neglect and despair.

A quick glimpse at the Naga Hospital Authority Kohima (NHAK), supposedly the State’s largest and most advanced government hospital in the State’s capital, reveals a stark reality. Take, for instance, NHAK was equipped with only four dialysis machines three years ago, highlighting severe shortages in essential medical infrastructure. Many of the inpatient cabin rooms are semi-private, which significantly increases the cost of hospitalisation. Compounding these issues, a significant proportion of prescribed medications are frequently out of stock within government pharmacies, forcing patients to purchase them from private vendors at higher costs. This not only increases the financial burden on already vulnerable individuals but also highlights systemic deficiencies in supply chain management, procurement processes, resource allocation and healthcare planning. If this is the condition at the supposedly state's largest and most advanced hospital, what is happening in the other parts of the state? What happened to the state-of-the-art solutions in healthcare infrastructure, supply chain management, and resource allocation aimed at improving accessibility, affordability, and quality of care in government hospitals? 

Despite the advancements and plans envisioned, these solutions often remain unimplemented or inadequately maintained. In his budget speech for FY 2025-26, the Chief Minister highlighted that the Health and Family Welfare department has been allocated Rs 9.46 crore for various infrastructural developments, including the construction of Community Health Centres (CHCs), Primary Health Centres (PHCs), offices, staff quarters, health sub-centres, as well as improvements to existing facilities and a patient lodge at the District Hospital in Dimapur. Additionally, a total of 12,047 beneficiaries benefited from the Chief Minister’s Health Insurance Scheme (CMHIS), with 66 hospitals empanelled both within and outside the state. Sadly, such claims remain effective only on paper; in reality, the situation is quite different.

The gap between public health schemes and ground realities shows a disconnect between policy and actual healthcare delivery. Conceptually, critics argue that Universal Health Care (UHC) primarily offers access to biomedical healthcare through insurance, focusing on secondary and tertiary hospitals. It overlooks social health determinants and neglects primary care, which addresses most health issues. Even within the severe limitations of secondary and tertiary care facilities, Nagaland faces more pressing challenges. Widespread corruption and ineffective governance undermine the quality, accessibility, and efficiency of healthcare services. Take, for instance, the implementation of health insurance schemes like Ayushman Bharat (ABPM-JAY) and CMHIS has been flawed. Private hospitals in Nagaland suspended services under ABPM-JAY and the CMHIS from February 5, 2025, until all claims were settled (The Times of India, 2025). During an emergency meeting, the Nagaland Private Doctors Association (NPDA) decided to suspend services under ABPM-JAY and CMHIS until claims were settled. The NPDA criticised the Nagaland Health Protection Society (NHPS) and Future General Insurance (FGI) for failing to fulfil their obligations under the memorandum of understanding, accusing them of misleading the public and blaming private healthcare providers. The challenges extend beyond insurance and administrative disputes. Even hospitals that are empanelled under these health schemes often lack essential medicines and testing facilities, forcing patients to pay out-of-pocket for necessary treatments. Furthermore, expenses related to travel logistics for family members or caregivers to other cities are not accounted for, further emphasising the financial vulnerabilities faced by the community in accessing healthcare. 

Undoubtedly, there have been significant improvements in healthcare infrastructures over the years. For instance, when Nagaland achieved statehood in 1963, its health infrastructure was modest, comprising just 27 hospitals and 33 PHCs, with a total of 689 hospital beds and limited numbers of doctors and nurses. The current public health infrastructure in the State includes 11 district hospitals, 42 CHCs, 164 PHCs, 643 sub-centres, and 49 health and wellness centres, along with specialised facilities like 2 TB hospitals, post-mortem centres, Ayush hospitals, and nursing schools (Nagaland Statistical Handbook, 2025). In 2023, Nagaland launched its first medical college, Nagaland Institute of Medical Sciences and Research (NIMSR), with 100 MBBS seats, and a second college is under construction in Mon, expected to open by November 2026 (The Naga Republic, 2024). These initiatives aim to address regional staffing shortages and train future healthcare professionals. Despite this progress, Nagaland lacks comprehensive diagnostic and curative facilities, forcing residents to seek services elsewhere, leading to delays, higher costs, and logistical challenges. What is even more heartbreaking is that the majority of the population cannot afford to seek treatment elsewhere and are left to fend for themselves, while the State entirely shirks its responsibility.  

It is equally crucial to highlight the interconnected spectrum of historical, political, socio-economic, and cultural factors when evaluating health outcomes in Nagaland. This is particularly important because health is influenced not solely by biological or medical factors but predominantly by the social environment. For example, modest improvements have been inconsistent across the state, with notable disparities between districts, and access to healthcare remains limited, especially in rural regions. Consider the case of Mon district. The district has a limited number of healthcare facilities suited to its predominantly rural and hilly population. The district currently has one district hospital, seven CHCs, 16 PHCs, 80 sub-centres, along with a dispensary, a post-mortem centre, an urban public health centre, and two health and wellness centres (Nagaland Statistical Handbook, 2025). Despite government efforts to integrate healthcare programs, challenges remain, including shortages of beds and specialists, and an increasing Infant Mortality Rate (IMR). In 2024-25, the total bed capacity was 210, with 100 beds in the district hospital, 40 in CHCs, 64 in PHCs, and 6 in urban public health centres, serving 6,295 inpatients and 133,091 outpatients during that period (Ibid). These figures reflect a high patient volume compared to available capacity, underscoring the strain on healthcare infrastructure, which hampers the district’s ability to adequately meet the community’s healthcare needs, potentially leading to compromised care quality, longer waiting times, and increased burden on healthcare providers.  

Compounding the issues is the lack of transparency and accountability on the part of the authorities, as well as the absence of strong pressure groups such as opposition political parties, civil bodies, tribal organisations, students' unions, community leaders, and individual stakeholders. In effect, a nexus of power dynamics creates a vicious cycle of paradoxical situations. This includes blame shifting between stakeholders while simultaneously being interdependent on one another, which perpetuates ongoing challenges. The imperative necessity is to place the healthcare sector firmly under public stewardship, for nothing holds greater significance than health itself, not even allegiance to one’s community, political party, or tribe. Illness transcends tribal boundaries and afflicts all living entities indiscriminately.

Reference:
Kamei, Panti. (2025). The Export of Vulnerability: Rethinking Nagaland’s Healthcare Deficit.  Kariu-Karamei Musings. Available at The Export of Vulnerability: Rethinking Nagaland’s Healthcare Deficit 
ICMR-NCDIR. (2021). Profile of Cancer and Related Health Indicators in the North East Region of India-2021, Bengaluru: ICMR-National Centre for Disease Informatics and Research.  
Nagaland Statistical Handbook, 2025. Directorate of Economics and Statistics, Government of Nagaland.   
The Naga Republic. (2024). “Mon Medical College expected to complete by 2026,” November 2024. 
The Times of India. (2025). “Nagaland pvt hosps to halt services under 2 health schemes,” February 10.