The Health Sector in the North East has been affected because of the gaps in infrastructure and human resources. Lack of infrastructure and manpower had adversely affected health service delivery, impacting disease prevalence and key health indices. Diseases like malaria, tuberculosis and respiratory diseases, HIV/AIDS continue to be major public health issues in the region. The rate of growth of population has also been an area of concern.
The North Eastern region comprises of the states of Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura. While Sikkim is a little away perched on top of the narrow Siliguri corridor in West Bengal, Assam is surrounded by the other six states – all of them sharing borders with Assam. Assam is dominated by plains and the mighty Brahmaputra while the other states are predominantly hilly. The region is characterized by high biodiversity, heavy precipitation, annual floods along the Brahmaputra and high seismicity. The geographical setup and the terrain of the region ensures poor accessibility and renders communication difficult in the region.
The North East region has also an extraordinary diverse ethno-geographic diversity. There are many tribes in the region with their own rich languages, social practices and traditions. However, because of the complex problems of historical neglect, rapid social and political changes, the region could not develop to its full potential.
Political evolution, reorganization of state boundaries, insurgency, low resource base inhospitable terrain, remoteness from the mainland and late introduction to Planning process for some of the states have, among other factors, contributed to the region remaining under developed especially in terms of infrastructure, communication, health care facilities and human resources. Keeping this in mind, the Central Government has earmarked 10% of its Plan funds consistently since 1998-99 in order to enable the North East to catch up with the rest of the country, especially with regard to its infrastructure deficiencies.
Focus of Health Sector
The Health Sector in the North East has been especially affected because of the gaps in infrastructure and human resources. Lack of infrastructure and manpower had adversely affected health service delivery, impacting disease prevalence and key health indices. Diseases like malaria, tuberculosis and respiratory diseases, HIV/AIDS continue to be major public health issues in the region. The rate of growth of population has also been an area of concern.
The health sector in the North East is largely dependent on the Government. Malaria morbidity and mortality in the North Eastern states are major public health concerns. Tuberculosis is another area of concern.
HIV/AIDS is also a major health concern in the North East, especially in the states of Manipur and Nagaland, which are high prevalent states. The disease is also raising its head in the states of Meghalaya and Mizoram. Unlike the rest of the country, where the major route of transmission is sexual, in the NE states, particularly Manipur, Nagaland and to some extent in Mizoram and Assam the unsafe injections by intravenous drug users are a significant mode of transmission in addition to unsafe sex. In Manipur, IDU account for nearly 45% of the total transmission in the state.
Cancer is another major health concern in the region. Keeping in view the fact that the Ministry of Health & Family Welfare was not able to spend the 10 percent of the Plan Budget allocation for the North Eastern region, as per the stated policy of the Government, specific steps were taken towards this direction to take care of the systemic rigidities and lack of capacity. A Special North East Division was constituted within the Ministry, considerable flexibilities were built in for the North Eastern region within the Implementation Framework of the National Rural Health Mission and for the capacity building requirements of the eight North Eastern states, a Regional Resource Centre was set up at Guwahati. With sustained efforts, the expenditure from the Plan Budget of the Ministry has picked up from Rs. 301.56 crore in 2000-01, Rs. 479.68 crore in 2005-06 to approximately Rs.850 crore in 2006-07. The expenditure is likely to be more than Rs. 1000 crore during the current financial year. It is expected that along with the increase in expenditure there will be an improvement in service delivery through the public healthcare delivery system of the region and corresponding improvement in the health indicators.
National Rural Health Mission
The National Rural Health Mission (NRHM) is the flagship umbrella programme of the Ministry and was launched by the Prime Minister in 2005. The Mission has received very enthusiastic support from the eight NE states. The Mission has, with its focus on improvement and bringing about reforms in the entire health sector by way of innovative management through capacity building, innovative human resource management, involvement of the community in planning and management, flexible financing and strengthening of institutions against desirable standards given the necessary tools to the Governments of the region to improve the health care delivery to their people and the enthusiastic response from them is definitely translating into better outcomes.
With a view to improve the management of the health sector programmes, the Mission has steered away from the way our health sector programmes have been traditionally managed and merged the stand alone, vertical programmes. The emphasis of the initial period of the launch of the NRHM was on preparatory activities in the form of setting up Institutional Framework, setting up of State & District Health Missions, merger of vertical societies as well as Departments of Health and Family Welfare, conduct of facility surveys, etc. which helped us define the strategies and guidelines for the coming years.
From the second year of NRHM there is increased focus on improved service delivery especially improvement in institutional deliveries and immunization, further strengthening the institutional framework right down to the Block levels, focused stress, greater convergence within the health sector programmes etc. in keeping with the Mission’s aim of providing universal access to health care in accordance with the needs of the people, bringing about reduction in child and maternal mortality, population stabilization, communicable disease control etc. There has also been increased focus on improvement in institutional deliveries and immunization, further strengthening the institutional framework right down to the Block levels, greater convergence with the health sector programmes, interventions to improve infrastructure from the Sub Centres up to the District Hospitals, fresh infusion of Specialists, Medical Officers, Programmes Managers, ANMs, improvement in drugs and distribution logistics, etc. in keeping with the Mission’s aim of providing universal access to health care in accordance with the needs of the people, bringing about reduction in child and maternal mortality, population stabilization and communicable disease control. ASHA has been received very enthusiastically. All villages in the region are being covered by an ASHA.