Nagaland scores poorly in coverage of key health programmes

Eastern Mirror Desk

Dimapur, Sep. 3 (EMN): There is a wide gap in the coverage of key programme activities under Women and Child Development (WCD) and Health departments in north-eastern states, especially Nagaland, according to a report by the Central government’s think-tank NITI Aayog.

The report titled ‘Preserving progress on nutrition in India: Poshan Abhiyaan in pandemic times’ showed Nagaland performing poorly with a score of one out of a total value of 12 in the programme activities and intervention coverage domain. (Refer table 1)

It stated that there is scope for small states like Nagaland to improve the coverage of interventions during the first 1,000 days, and focus on child immunisation, antenatal care (ANC) check-ups, and the use of oral rehydration solution (ORS) for treating diarrhoea.

The report also suggested strengthening the service delivery across anaemia interventions.

It may be mentioned that Poshan Abhiyaan is the government of India’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers, and adolescents.

To assess the implementation progress of the programme in all states and UTs, data were collected from the state/UT WCD and Health departments on four key themes related to the inputs and activities under Poshan Abhiyaan for March 2020. These include governance and institutional mechanisms, strategy and planning, service delivery and capacities and programme activities and intervention coverage.

States were divided into three categories — large (19), small (eight) and union territories (eight). The eight small states were Nagaland, Arunachal Pradesh, Goa, Manipur, Meghalaya, Mizoram, Sikkim, and Tripura.

In terms of overall implementation of the programme in states and UTs, Maharashtra, Andhra Pradesh and Gujarat had the highest achievements. Twelve out of 19 large states had an implementation score of over 70%. Among the eight small states, Sikkim was the highest performer in Poshan Abhiyaan overall implementation (more than 75%), followed by Meghalaya, Tripura and Goa. Nagaland had an overall score of 51%. (Refer table 2)

Dadar and Nagar Haveli and Daman and Diu, Chandigarh, and Andaman and Nicobar Islands were ranked the top three UTs with score of over 70%.

On governance and institutional mechanism, the maximum score given to a state/UT was 12. The utilisation of funds and the constitution of resource groups and committees improved and as a result, states and UTs scored high on this theme, said the report.

Utilisation of funds under Poshan Abhiyaan

All states/UTs received funds under the Centre’s flagship Poshan Abhiyaan except Ladakh, which received a portion of central funds of Jammu and Kashmir.

According to the report, utilisation of fund under the Centre’s flagship programme was highest in Kerala (58%) and lowest in Odisha (8 per cent) among larger states by the end of FY20.

Among the small states, fund utilisation was highest in Nagaland (87%) and lowest in Arunachal Pradesh (9%), while among UTs, fund utilisation was highest in Lakshadweep (65%) and lowest in Puducherry (22%).

The report stated that four states (Nagaland, Meghalaya, Mizoram, and Tripura) distributed 100% of mobile phones, and four states (Nagaland, Goa, Meghalaya, and Mizoram) had distributed 100% of growth monitoring devices. Supplies were lowest in Arunachal Pradesh (0% mobile phones, infant weighing scale, and adult weighing scale; 2% infantometers; 2% stadiometers were distributed) and Manipur (21% mobile phones; and 0% growth monitoring devices).

Two states (Goa and Sikkim) have 100% functional sub-centres; four states (Goa, Manipur, Meghalaya and Sikkim) have 100% functional Community Health Centres; and two states (Nagaland and Goa) have 100% functional Health and Wellness Centres, according to the Niti Aayog report.

The results indicated that Arunachal Pradesh (63% of sub-centres and 39% of HWCs) and Nagaland (76% of sub-centres and 64% of CHCs were functional) should focus more on infrastructure.

Meanwhile, six states (Nagaland, Arunachal Pradesh, Goa, Manipur, Meghalaya, and Sikkim) had filled more than 75% of the auxiliary nurse midwife (ANM) positions. Tripura (56%) had filled less than 75% of ANM positions. 12 large states, four small states (Nagaland, Meghalaya, Mizoram, Sikkim), and four UTs had filled 100% of joint project coordinator positions.

Only 13 states and UTs had more than 75% of pregnant women registered for antenatal care

(ANC) in the first trimester. A total of 19 states had more than 75% of pregnant women who had four or more ANC visits. Nagaland, Punjab and Tripura had less than 25% of pregnant women attending four or more ANC visits.

In addition, there were large gaps in staff training on e-Integrated Learning Approach (ILA) modules across several states, due to low attendance at training, unavailability of training materials, lack of trainers, and low educational background of anganwadi workers.

Only 37% of funds utilised

Furthermore, it stated that states have been utilising flexi funds for organising various events and camps that help in meeting the objective of the Abhiyaan.

It indicated that on average, States/UTs have utilised 37% of the funds earmarked to the states up until March 31, 2020.

The Niti Aayog report informed that the flexi fund approved by the State Level Sanctioning Committee (SLSC) for Nagaland was INR 213.55 lakh.

The fund for the state was utilised for purchase of smokeless Chullas for Peren district, one-time grant to anganwadi centres for community-based events, establishment of 22 nutri-gardens, ILA takeaways for 21 modules (25 Takeaways), Integrated Child Development Services Common Application Software (ICDS-CAS) training for anganwadi workers, lady supervisor (LS), development project officers, child development project officer and state officials, according to the report.