Saturday, March 25, 2023


A recent report released by the Union Ministry of Health and Family Welfare has highlighted the sickly state of rural healthcare in Nagaland. 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 her broadly spread rural populace. So far (going by the 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). Even by a generous assessment, that is barely above non-existent. Specialists aside, Nagaland also suffers from shortage of regular doctors at Primary Health Centres (PHC) established in its rural areas. The Ministry data show that the requirement of regular doctors at PHCs was one at each Centre: 131 doctors at 131 functioning PHCs spread across rural Nagaland. Against this, the Government has filled in only 123 posts. In the case of specialists, the equation presented by the Ministry report is: 84 specialist doctors required at 21 CHCs functioning in Nagaland. The doctor-population ratio recommended by World Health Organisation (WHO) is 1:1000 ~ in other words, 1 doctor per 1000 citizens. Against the WHO benchmark, the report card for Nagaland reads like this: 1 specialist doctor for 2,01,076 rural citizens and 1 regular doctor for 11,443 rural citizens. This is where things get interesting. As per a report in one of our local newspapers, the doctor-population ratio for Nagaland, in general, is 1:2000. Not good enough, by any measure, when held up against the WHO standard. But put that figure next to the ratio of doctors and specialist doctors in rural Nagaland and the chasm asks only one question: where are all the doctors posted then? Even after taking into account the fact that the ratio for Nagaland is inclusive of private practitioners, the gap is simply too wide for the inclusion of private doctors to be an alibi. Successive Governments that have come to power in Nagaland have neglected the Health sector in general. But when it comes to healthcare delivery in the rural areas, they have been dismissive. Recall how the disparity came to full focus when the COVID-19 pandemic first breached our (poorly-guarded) gates. And till date, the Government is yet to come up with anything resembling a serious blueprint to even begin with the patchworks. More occupied with needling of another kind, one might say. There is also the matter of reluctance among Government employees, including those in the Department of Health and Family Welfare, to work outside of Kohima, Dimapur or their respective home districts. In fact, the Ministry’s report showed that 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. To wit: shortage of 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. These contrasting features, in their own ways, indicate the disarrayed structure, insensitive and irresponsible management of the healthcare system in Nagaland. Too many years of comfortably-numb politicians and officials at the helm of one of the most important, if not the most, constituents of public welfare: healthcare. The pandemic, devastating as it is, has been a grim reminder to the State of an unadorned truth around which it has dangerously skirted for far too long. The Union Ministry’s report card, then, is merely a recap of that warning: a State neglects healthcare to its own peril.