CAG report exposes severe healthcare staff shortages, uneven distribution, and infrastructure gaps across Nagaland, affecting patient care and services statewide.
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DIMAPUR — Nagaland is grappling with a severe healthcare manpower shortage, with deficits spanning across multiple categories, according to the Comptroller and Auditor General of India (CAG) report tabled in the state Assembly on March 26.
The report revealed a shortfall of 205 doctors, 321 medical officers (MO), 25 dental surgeons, 108 AYUSH medical officers, 1,955 nurses, 1,352 allied healthcare providers and 100 health assistants.
It highlighted that the department of Health and Family Welfare continues to function with many constraints, resulting in inadequate availability of specialist doctors across district hospitals (DH), community health centres (CHC) and primary health centres (PHC).
Although provisions exist under the National Health Mission (NHM) to address such gaps, many eligible doctors are reluctant to join government service due to more attractive opportunities in the private sector, it stated.
At the district hospital level, the report stated, shortages were particularly acute. The deficit of specialist doctors ranged between 8% and 56%, while shortages of general duty medical officers ranged from 43% to 100%.
Staff nurse shortages ranged from 4% to 60%, and paramedical staff shortages from 13% to 88%. Despite these gaps, excess specialist doctors were observed in two district hospitals, pointing to uneven manpower distribution.
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The report highlighted disparities in the availability of specialists across districts. Shortages in general medicine were recorded in Kiphire, Peren, Longleng, Phek, Zunheboto and Mokokchung, while Kohima and Dimapur reported excess availability.
Similar imbalances were observed in paediatrics (Peren, Mon, Phek, Tuensang, Zunheboto and Mokokchung) and across other key departments, including ENT, orthopaedics, general surgery, ophthalmology, obstetrics and gynaecology, anaesthesia, radiology and pathology.
Only District Hospital Kohima met the required norms for specialist availability across all 11 mandatory departments. In contrast, most district hospitals lacked adequate specialists in multiple disciplines, reflecting the absence of a systematic policy for equitable distribution of medical personnel.
Community health centres also faced critical shortages. The deficit of specialist doctors ranged between 67% and 95%.
Out of 23 CHCs in the state, obstetrics and gynaecology services were available in only five—Noklak, Pungro, Jalukie, Meluri and Tobu. Shortages were also reported among general duty medical officers (29%), nurses (62%) and paramedics (12%).
At the same time, excess manpower in select CHCs—Obstetrics & Gynaecology (Pungro); MBBS-MO/SMO (Noklak, Medziphema, Bhandari, Jalukie, Pungro, Tuli, Dhansiripar, Meluri, Longkhim, Tobu); staff nurse/ANM (Noklak, Jalukie, Changtongya, Meluri); lab technician (Medziphema, Bhandari, Jalukie, Pungro, Tseminyu, Changtongya, Tuli, Dhansiripar, Sanis, Pfutsero, Pughoboto); and pharmacist (Noklak, Tseminyu, Viswema, Changtongya, Pfutsero)—indicated skewed deployment practices.
Primary health centres and health sub-centres were similarly affected. PHCs reported shortages in general duty medical officers (11%), auxiliary nurse midwives (86%), lab technicians (64%) and pharmacists (33%).
Overall, 52% of health sub-centres in the state were found to be functioning with inadequate staff.
Beyond manpower, the report flagged major gaps in infrastructure and diagnostic services. Advanced procedures and tests such as endoscopy, bronchoscopy, arthroscopy and CT scans were not available in district hospitals. Echocardiography services were limited to District Hospital Kohima.
Due to the lack of emergency and specialist services, patients are frequently referred to higher centres, increasing delays in treatment and out-of-pocket expenditure.
All district hospitals in the state were found to be segregating biomedical waste into different categories using colour-coded bins, in compliance with the Bio-Medical Waste Management Rules, 2016. However, the waste was later mixed during disposal and dumped in deep burial pits.
The report further stated that out of 11 district hospitals, only seven—Phek, Wokha, Kiphire, Dimapur, Mon, NHAK and Zunheboto—had mortuary services. However, facilities for preservation of bodies and conduct of autopsies were not available.
Ambulance services were also found lacking, with many vehicles not equipped with basic life support systems or trained personnel. Although 102 national ambulance service vehicles were sanctioned, only 93 basic life support ambulances were operational, and advanced life support services remain unavailable.
It stated that only five of the 11 district hospitals had functional blood banks, while some facilities lacked basic infrastructure such as power backup.
Although biomedical waste segregation was being carried out, improper disposal practices were observed.
It also flagged financial and administrative lapses, including underutilisation of pandemic funds amounting to INR 18.97 crore, delays in land acquisition for the Nagaland Medical College in Kohima, and issues such as fund diversion and delayed submission of utilisation certificates.