Sunday, December 3, 2023

Unhealthy attachment

Two weeks ago, at the 22nd hearing in connection with a suo moto PIL against the State’s Health and Family Welfare Department, the Kohima Bench of Gauhati High Court was informed that the former has finally managed to “detach” all doctors and sent them to their original places of posting. Additionally, the Department told the Court that other medical personnel, besides doctors, have also been detached. Five months prior, on April 20, the Court had pointed out to the Department the “glaring” instance of 10 doctors being attached to Naga Hospital Authority Kohima (NHAK) from other health centres of the State. It then ordered the Principal Secretary of Health & Family Welfare to explain why some health centres in the State were functioning without any medical personnel while many medical personnel, including doctors, were attached elsewhere than their places of posting. Then came the Court’s observation that should embarrass the Health authorities of the State, led by the Minister-in-charge: “Without any or adequate number of medical personnel, existence of CHCs, PHCs and sub-centres do not serve any purpose”. It is no secret that most Nagaland Government employees, including those in the Department of Health and Family Welfare, are loathe to work outside of Kohima, Dimapur or their respective home districts. In the health sector, the problem is compounded by a lack of medical personnel in the State. We have a situation where there is acute shortage of doctors and other medical staff while those in service are reluctant to serve outside Kohima and Dimapur – thus doctors and medical personnel being “attached” to the NHAK and health centres not located in remote areas. It is worth recalling that in the early months of this year, the Union Ministry of Health and Family Welfare released a report that highlighted the ailing state of healthcare in Nagaland, especially in the rural area. Chief among the diagnosis was the absence of 77 specialist doctors at Community Health Centres (CHC). As per the Ministry’s Rural Health Statistics (RHS) of 2020-21, Nagaland requires 84 specialist doctors to tend to the rural populace. So far (going by the Ministry report), the State Government has managed to recruit only seven specialist doctors – such as surgeons, obstetricians, gynaecologists, physicians and paediatricians – to look after the health and well-being of more than 71% of Nagaland’s total population (as per the 2011 Census). Specialists aside, Nagaland also suffers from a shortage of regular doctors at Primary Health Centres (PHC) established in its rural areas. The Ministry data showed that the requirement of regular doctors at PHCs was one at each Centre: 131 doctors at 131 functioning PHCs. Against this, the Government has filled 123 posts. In the case of specialists, the equation presented by the Ministry report was: 84 specialist doctors required at 21 CHCs functioning in Nagaland. The doctor-population ratio recommended by World Health Organization (WHO) is 1:1000 – one doctor per 1000 population. However, according to the Nagaland Medical Students’ Association, the ratio in Nagaland is 1:4000. Per the Ministry’s report, except for nursing staff and female health workers/auxiliary nurse midwife (ANM), Nagaland has a shortage of all other health workers in its rural areas. The shortages bear repeating: 28 Pharmacists, 11 Laboratory Technicians and 16 Radiographers. In contrast, we have an excessive number of nursing staff at PHCs and CHCs as well as female health workers/ANM at Sub-Centres and PHCs: 398 nursing staff members against the required 278 and 1008 female health worker/ANM against the required number of 558. The RHS (2020-21) revealed that the number of specialist Doctors, Pharmacists and Lab Technicians saw a decline from its previous report. Meanwhile, regular Doctors, Nursing staff and Radiographers increased in number. Against such a grim scenario, the intervention of the High Court has finally resulted in the “attached” medical workers, including doctors, being dispatched to their original places of posting. But the very fact that it took the intervention of the Court for this to happen says all we need to know about the sickly state of our healthcare system.