Towards Adequate and Equitable Distribution of Health Facilities in Nagaland

The current Covid -19 pandemic has put a reality check on the inadequacy and inequitable distribution of health facilities in the state of Nagaland. The present Government has the right to blame the earlier successive governments since statehood for this particular issue. However, development of Health services and infrastructure even in the last few years has followed the same trajectory. This is further proved with the unfair prioritisation and distribution of health facilities and resources in the current Covid -19 scenario. A cursory glance at Nagaland Government internet portals on Medical infrastructure and resources is enough to showcase the alarming inadequacy and inequitable distribution of health facilities in the state.

A quick comparative analysis shows a lot of disparity in the devolution of health facilities across the state. Kohima with a population of 309,107 (https://indiapopulation2019.com/population-of-kohima-2019.html) has 110 doctors and 359 nurses on duty, while Mon District, with a population of 274,116 (uidai.gov.in, feb 2019 data) has 37 Doctors and 155 nurses on duty. While the Government sector doctor-population ratio of Kohima district stands at approximately 1: 2810, for Mon district it stands at approximately 1: 7408. While Kohima District has 90 beds available in Covid Hospitals, Longleng has 15 beds available in Covid Hospitals and while Kohima District has 10155 N95 Masks, Zunheboto District has 2350 N95 Masks. Similar disparity in Medical facilities as well as in the allotment of Covid-19 funds is seen in the other districts. Within this inadequacy and disparity, a check on ground reality will certainly surface more grey areas in the furnished government figures. The figures do not include the huge number of medical professionals and infrastructure in the private sector. We have to keep in mind that Kohima and Dimapur have good infrastructure and medical professionals in the private sector.

This clearly establishes the reality that only the affluent section of Naga society have easy access to the best available medical facilities in the state. The poorest of the poor living in remotest villages face a lot of problems in accessing these services because of money involved in travel and accommodation for the attendants and patients. Even though government hospitals provide ‘subsidised’ or ‘free treatment’ and has made ‘Ayushman Bharat Yojana – PMJAY’ available to the poor, travel and living cost of OPD patients and attendants of patients admitted in government hospitals are very high. So then, it is irrational to perpetuate the idea and practice that Kohima and Dimapur should be the medical treatment destinations for the people of Nagaland.

Nagaland Government has promised to establish BSL-2 in Tuensang but what about manpower – Technicians, Mocrobiologists, Virologists, Doctors, Specialists and Nurses. What about other medical infrastructure – building, beds and machines as Ultra Sound, MRI, CT Scan, etc? So then what Tuensang public said, “Don’t appease us with Marie biscuits and a glass of water” in response to Nagaland Government’s promise to set up BSL-2, makes sense. This ugly reality and the recent turn of events apply to all the other neglected districts.

With immediate attention to providing equitable medical facilities in the districts relating to Covid -19, Nagaland Government should plan and work out fair and equitable development of medical infrastructure in a carefully planned phased manner. In the major urban centres like Dimapur and Kohima, private Health sector has come up pretty well and still have huge scope of resources to develop further. So then it makes all the more sense to devolve more resources in semi-urban centres. Besides, there is also an urgent need for the Government to establish a Medical College and Super Speciality Government Hospital/s with special focus on Oncology, Cardiology, Nephrology and Biliary departments.

A well informed and vigilant public is also required to check Government on unfair distribution of health resources, misuse of health related funds, irresponsibility of medical professionals (especially absenteeism), if any. The collaborative initiatives of public organisations and government especially in handling Covid-19 related tasks should not in any way weaken the right of the public organisations to question and pressurise the government. However, in doing so, the public organisations should not use herd mentality or endorse petty sectarian agenda but rather advise and pressurise the Government backed by proper analysis and research.

Dr. Walunir