Dr. Nandira L. Changkija
Health per se, with its entire gamut of the delivery system has evolved into highly technical and skilled processes, ensuring the two prongs of preventive and curative aspects, function in tandem and harmony. Multiple factors that influences decision making and planning involves technical/descriptive inputs from health professionals, care providers, retrospective results/data, disease trends, beneficiaries, and a host of regulatory indicators. Thus a robust system- whereby qualitative , quantitative and achievable parameters for implementation, become benchmarks for result oriented performance and future strategies. The Vision 2030 hopefully incorporates all these areas of concern with an inclusive/ comprehensive participation of all stakeholders that should definitely include technical experts specifically from the fields of Medicine and Public Health.
Often, key areas of decision making pertaining to program implementation, finances, skill development/capacity building and HR management – where shared responsibility and transparency reflects the capability and expertise available in the Health Department is totally underutilised and disregarded. It is also pertinent to point out that, in order to avoid repetition of past errors, previous vision documents and departmental annual report card/data for last decade be scrutinised to realistically asses achievements, errors and plan better for the future.
In order to do justice to the populace for whom the vision documents are formulated 15 years hence-whether health or any other sector, proposals that are documented should have relevance for the future.
Few suggestions for the Health sector, are put forward prior to finalization of the vision documents :-
a). State Health Policy –mandatory and should have been in place soon after statehood.
-Implementation of the Nagaland Health Establishment Act 1997 should be made effective at the earliest as it addresses issues relating to both qualitative and quantitative yardsticks for the health care delivery system in major aspects.
b). Delay in establishing a Medical College till date. This has inadvertently affected the subsequent additions of a Dental College, Nursing College and other Paramedical Colleges/institutes. Nagaland has adequate qualified professionals to kick start such mega projects in comparison to our neighbouring states including Mizoram. However there is acute shortage of political will and failure to acknowledge locally available wealth of Human Resources. Outsourcing Governmental enterprises to private agencies does not speak much on the capacity/confidence building measures and are seen as mere rhethorics.
-Optimal and judicious utilization of qualified HR in any category is grossly under utilized –whether from the private sector/ reutilization of retired professionals on short term basis –based on needs assessment. Very rarely Technical professionals of most departments including Health are gainfully utilized, for their expertise and experience post retirement, in advisory roles and benefit the state as a whole. Today’s world places great emphasis on the concept of ‘Think Tanks’ for strategic planning and Policy formulation as economics and financial inputs for the health sector ultimately will determine the quality of service delivery .
c). Incomplete mega structures and infra structures with poor quality workmanship . Majority of the health facilities are planned without proper hospital oriented architects, not easily accessible (far away from the community with no approach roads etc.) without power/water/proper sanitation –in short- not client friendly ! Facilities for the care givers- in terms of accommodation and other basic amenities, have never been upgraded as per norms and in proportion to increase in service delivery over the years.
d). Health Insurance –under the Universal Health Coverage that has been rolled in majority of the states including Meghalaya, Mizoram, Tripura and Assam, the need of cutting the burdens of’ out of pocket’ (OOP) for the citizens requires urgent implementation by the departments concerned and political will of the government. Public awareness to the immense benefits of the insurance policy should be debated at all levels of the society.
e). Major concerns in the Vision 2030 documents should have comprehensive strategies to focus on the rising trends of communicable, non-communicable , lifestyle diseases(-diabetes, hypertension ,cancer, etc), aging population (Grey tide), Mental health issues, impact of water/sanitation/climate changes , diseases due to addictive behaviours etc. , with planned measures to address them.
The aim of this article is to invite a healthy public discourse and debate on how the systems in the state are developed –including health-for the generations to come and the generation growing with the tide.
