Health Care System in a Remote District

    The health care systems in my district Saiha were always a cause of concern for me from the moment I have come to this place, but today after witnessing death of one of the Sub Inspector Sh Lalawmpuia Sailo working with Saiha Police, I am feeling very sad and helpless. He was quite young and was an alcoholic but this was not the age to die. Anyone may attribute the apparent cause of death as chronic alcoholism and level failure, but it also indicates the inadequacy of our health care system to correctly diagnose and offer a reliable solution to the diseases. The condition of hospital is appalling and the equipments available here is highly inadequate. One can understand the status of hospital by looking at the photos posted below.

Entrance to the Wards

Male Ward

     These two photographs can illustrate the prevailing condition of the hospital. Let me state that there is no VIP ward or anything else.... This is the only male ward. Similar is the case of Female Ward. Children Ward is under construction. Actually we shifted nurses room and renovating that room for using that as Children Ward.

Casualty

     The hospital wards are running in Assam Type Structures (Tin Roof & Tiles as wall) and the building is very old. The proposal for construction of new civil hospital has been sent to Ministry of DoNER and has been retained under perpective plan but no sanction has been made so far. The Secretary, DoNER when she visited Saiha has assured that it will be taken up soon and we are waiting for a positive response soon as her visit was in October, 2010 only and for NLCPR, M/oDoNER, the committee sits monthly once all clearances are taken from concerned departments.

     In a typical district, the health system is organised in two strands: male-female health workers based sub centres connected with Primary Health Centres(PHC) which is manned by a general physician and one specialty hospital at district level. A common remote and backward district faces problem in management of all the strands of the health system. In remotest places no health worker wants to go and  maximum vacancies of health workers are noticed at places where they are needed more. Thankfully because of NRHM, ASHA workers are appointed in every village alongwith Anganwadi Workers who are lifting up the basic health care standards. Since they are part time workers with basic training, they can not be expected to take care of all health problems. So functioning of a health subcentre is a must in every village or every two villages at most.      In last monsoon our experience was quite astonishing as the villages where connectivity was bad, there was no any health worker available and villages have been left on their own. When we forced them to go to interior places, lot of resistance was noticed.

     Similarly, the district is having 4 PHC but only one was functioning for want of doctor. The Govt is unable to find a suitable doctor to be placed in other three PHCs.

I feel a practical regime of transfer/posting of health professionals is required. The interior area allowance can be introduced as an incentive and a tenure system can be evolved to ensure that the interior area should get proper health facility. Since, the places with proper connectivity can always access the district hospital, so evenif these places run without adequate manpower, they can manage; but in interior areas which are very far and faces connectivity problem in rainy season, adequate healthworkers need to be posted alongwith adequate supply of machines. A pragmatic policy needs to be adopted.

     New schemes like RSBY is quite promising as these are going to make district hospital a corporate entity with incentive for doctors and earnings for hospital management and hopefully will free the hospital for purchase of necessary equipments and will provide enough resources to equip itself.

    Under district level schemes like BRGF, BADP, we are planning to equip the hospital with good machines, to provide good quarters for the doctors; but since health sector is quite capital intensive, these funds are insufficient to meet the requirements of the people and a special plan funding for purchase of necessary diagnostic and surgical equipments are necessary to make the district hospital a true First Referral Unit and to conform it to the Indian Public Health Standards.

    Although we claim to becoming a modern and developed nation and trying to gain proud entry in UNSC or other coveted bodies; but unless the remote places like these are taken care of by the system and society at large, we can not claim ourselves truly developed. The development of the nation depends on quality human resources and without a sound health system, a  pool of quality human resource can not be imagined.