Nagaland government committed to addressing inequities in health sector

Our Correspondent

Kohima, Nov. 24 (EMN): Minister of Health and Family Welfare, S Pangnyu Phom, stated that the government of Nagaland is committed to address the inequities that exist in the state especially in the health sector.

He stated this while addressing the Nagaland Health Project (NHP) (a World Bank aided project) culmination programme at Capital Cultural Centre on Thursday in Kohima. 

Stating that NHP is the first state-level project funded by World Bank and implemented by the department of Health and Family Welfare, Phom asserted that the project, with its focus on selected sites, had covered district hospitals, community health centres, primary health centres, sub-centres and its catchment villages.

The first project component, the minister informed, was focused on community result-based financing (RBF) where health intervention by health committees aim to improve health and nutrition outcomes at the community level based on the Nagaland communitisation concept.

 The intervention started in 2015 with Tuensang and Peren as pilot sites while today, this intervention has been done in 500 different health committees, he added.

Stating that the district level RBF intervention aimed to improve service delivery and quality outcome at the CMO and DH level, he informed that the same had started in June, 2021.

 “Today across all facilities, we can see changes not only in infrastructure development, but also in the management system, hygiene practices and quality of care,” he said.

Safe and readily available water, which is important for public health, whether it is used for drinking, domestic use, or other purposes was emphasised; while roof water harvesting was recommended as the prominent water source to cater to the day-to-day needs of the health facilities, Phom informed.

Civil repair and renovation works have been completed in four nursing schools and PMTI, nine district hospitals, and 158 targeted health facilities, he informed, adding that construction of state warehouse has been completed while repair and renovation work in two district hospitals and 18 health facilities is in progress. 

Construction of the library and theatre block at Nagaland Medical College Kohima, which is in progress, is also under Nagaland Health Project, he added.

Asserting that improper management of waste generated in healthcare facilities causes a direct impact on the community, healthcare workers, and the environment as a whole, the minister stated that during the preliminary assessment conducted in the year 2014, most of the health facilities were collecting all the hazardous and non-hazardous waste in a pit and burning it, which in turn was releasing harmful pollutants into the air. 

Considering the lack of proper management of bio-medical waste, the department under NHP had initiated activities to meet its social and statutory obligations for effective and sustainable bio medical waste management and as per provisions of Biomedical Waste Management Act, he said.

Since the inception, Phom informed that NHP has successfully signed 133 contracts, adding that it is also one of the first projects in Nagaland to adopt e-procurement for tendering.

Out of these, only 16 remain active, the works for the remaining 117 contracts are completed, he informed.

As of today, he stated that NHP on average has achieved 95% physical and 82% financial progress from the procurement section, which include infrastructural development and installation of solar plant at health facilities across the state, construction of deep burial and sharp pits in the health facilities for proper management of bio-medical wastes, supply of goods for healthcare systems, supply of IT equipments, consultancy and non-consultancy services etc. 

He updated that the project has also aided the construction of the upcoming medical college at Kohima by taking the initiative to construct the library and theatre block, adding that the contract was signed on January 2021 and the work is likely to be completed by July 2023.

Affirming that immense support to the department was provided by the project by supplying oxygen cylinders and concentrators across the state, he informed that in the midst of COVID, the project has also constructed oxygen generation plant houses at eight district hospitals and installed oxygen pipelines at various health facilities amidst the pandemic.

“Fostering the development of a clear, rigorous framework can bring extraordinary results, with positive impact on the welfare of thousands of households. Mitigation and adaptation efforts not only address existential threats but, as new technologies evolve and relative prices adjust, also create new jobs and increase productivity if capital flows are adequately steered,” he said.

“Availability of finance is a key challenge in facilitating systemic transitions. Simply put, what gets financed gets done. So, we must keep our ambitions high and act accordingly, with the right sense of urgency—and intellectual rigor,” he added.

NHP making strides in infrastructure development

Imnasenla Shanbur Jamir, consultant, World Bank, while dwelling on learnings and sustainability plan, stated that NHP has made great strides on improving the existing infrastructure through repair and renovations across district hospitals and health facilities.

Sharing their experience, she recounted how they learned that during the implementation of civil works, a detailed assessment of all sites should be conducted as per site-specific requirements before starting the works while mentioning how seasonal road conditions, difficult terrain, and skilled technician availability affects timelines; and therefore needs to be accounted for realistically.

‘A quarter of all deaths and diseases are attributed to environmental factors according to the

World Health Organisation, thus it is imperative that the healthcare industry not only look into treating people who are suffering but also by reducing its own emissions,’ she said.

She said NPH has made some significant impact in reducing a small degree of emissions in the state by addressing issues such as biomedical waste management infrastructures (construction of deep burial pit and sharps pit in 537 health facilities); trainings at all levels and developing the biomedical waste management system online to track the waste generated.

The setting up of RWH systems has resulted in targeted facilities gaining access to water supply during the lean season, thereby decreasing the cost of water purchased, she said. However, for this to be sustained, she said the department needs to set aside resources in maintaining and improving the RWH systems.

The project has also invested on installation of Solar PV Plant, solar street light, solar water pumps and solar water heaters in targeted health facilities, thereby resulting in 881 MWh of clean energy/year, Co2 offset of 530 tons per year and 53 lakh of electricity bill savings which could in turn be invested in the maintenance of the newly installed systems.

During the landscaping stage of the project, it was found that in most of the intervention sites (90%) the health committees were either defunct or dormant, she informed, adding that the project has successfully activated and reconstituted health committees as per the Communitisation Act 2002.

The consultant also pointed out that there was also a great need for a cross functional ICT core team and ownership by the department in the management, maintenance, and sustainability of health facility IT infrastructure.

Dr. K Vikato Kinimi, principal director and project director (NHP), department of Health and Family Welfare, stated that the project had a major focus on knowledge and skill building of the village health communities and other stakeholders; and committees are empowered to use incentives for health and nutrition activities. 

Reliable lighting and clean toilets in health facilities has helped reduce barriers in accessing health services, while health facilities are standing now as best examples to the community for safety, cleanliness and hygiene, he said.

Kinimi informed that the project has also developed an interoperable information and communication technology linked to high-priority applications like supply chain management, health information system, mobile applications, which are all intended to improve the management and effectiveness of government health services in Nagaland.