Why the public health focus in North East India remains necessary

Health is a component which is essential and is the right of every individual and the entitlement to it includes the accessibility of all the socio-economic determinants such as food , water, sanitation, safety, healthy working condition etc. People  strive to attain good health mostly after an onset of a disease which would require tertiary care. Therefore the health system’s major focus is on curative perspective, very less importance is given to the public health system or the preventive aspect of health. Many years back prevention and management has been our goal which is a population driven  health approach to promote healthy living, a healthy environment  yet with time the focus lies on curative and biological factors. India with a large population of 1.36 billion, has a total health spending of 3.6% of GDP as per Organisation for Economic co-operation and development (OECD) which is  low compared to other Low middle income countries (LMIC). Therefore the inadequate healthcare services could not maximize the health benefits to the people in the region.

NorthEast India is the eastern-most region of India which is one of the most underdeveloped regions of India, consisting of eight states commonly called the seven sisters that is Arunachal Pradesh, Assam, Meghalaya, Manipur, Mizoram, Nagaland, Tripura and one brother which is Sikkim. The Majority of the Northeast region’s economy depends on agriculture, tourism and allied activities. The northeast region has tough geographical terrain that causes an obvious hindrance to development because of the difficult transportation and communication compounded by problems peculiar to this area such as ethnic violence, economic backwardness, insurgent extortion networks, absence of quality education and porous international border. The region is rich in natural resources yet lacks in facilities to make an optimum utilisation.The existing healthcare facilities especially in the rural area are insufficient, lack quality and have shortage of skilled manpower. Even with the launch of NRHM in 2005 there is not much of improvement in the health facilities. The NER Vision-2020 document also talked about the overall improvement in the health status of the region.

In the Northeast the diverse ethnicity and difficult terrain poses a great problem to the people in the region to seek health services. The northeast has a high incidence of cancer which is seen distinct in some states like Meghalaya for Esophageal Cancer, Nagaland for nasopharyngeal cancer, Mizoram for stomach cancer, Arunachal Pradesh for liver cancer. Medical institutes and hospitals have been adopted by the government for curative care. The prevalence of high level consumption of tobacco is the high risk of cancer. Therefore the need for public health is very much important to make people aware and adopt a healthy lifestyle for preventive care and health seeking behaviour of the people. One has to travel to the other districts or states to avail healthcare services which cost more to the people. In view of cutting down the financial burden of the people programs and health insurance are available which sometimes are unspent and hence the people have to bear the out of pocket expenditure.  As we witness a lot of programs are present like Ayushman bharat and state insurance programmes to prevent catastrophic expenditure on healthcare services, yet implementation or access of the services is very much the need of the health system as there is inadequate human resources and quality services.  Enhancing the status of existing manpower, availability  of  specialists  and  well  trained  manpower,  quality  of  healthcare services would be of immense benefit to the region. For many years a lot of knowledge has been ingrained and practiced among people in the community with regard to keeping themselves healthy and boosting immunity but the practice is fading off as it has become outdated as people are tending to follow the so called modern lifestyle. Medical advice can be complemented with long used Traditional and folk medicine for preventive and therapeutic approach to mitigate the severity of the clinical outcome. Community participation by setting activities over the spreadhead of panchayats or municipal level is also a widely used strategy to reach out to the people in the past could be used today to ease the delivery of healthcare to people even in the rural areas.

The way ahead:

  • Digitalization and technology upgradation is an emerging mechanism that would improve quality and affordable delivery of services by encouraging webinar or online consultation
  • As the local experts rightly point out, local innovation and local adaptation is essential to bring about development of the region in public health. Assam’s Boat clinic initiated by NHM- a public- private partnership, has also brought about basic health services to the people in the region.
  • Focus on resolving the longstanding issues (eg. quality infrastructure, surveillance),  nurturing or retention of human resources for public health. These are few less discussed as considered old fashion.
  • Culturally sensitive hygienic practice could be encouraged more to promote healthy living Eg: Mawlynnong village in Meghalaya has been acclaimed Asia’s cleanest village. Welfare oriented progressive reforms in order to cut down problem of performance, efficiency and stratification
  • Urgent need of a multidisciplinary team working together with a people-centric engagement and work with the community to capture the living and livelihood of the people and take necessary public health action.

There is a greater need for formulating policies that adhere to the challenges and constraints of the region. Looking at the gravity of the situation it is essential to reach out to the vulnerable group and left out to prevent unavoidable circumstances. In order to make healthcare inclusive, it is essential to look upon deeper into the local requirements and need for public health so as to gain trust and sustain services in the region with the local dwellers. Hand holding is also important to entrust in the people the sense of ownership of the programs and activities in the area. Convergence of different government departments also is a need for focus to give way to uplift the development of the region. It is essential to have an equity lens that ensures no one is left behind. 

About the author: Fellicita Pohsnem works in the development sector with a major in health policy, economics and finance.

Disclaimer: Views expressed are the authors own. CHD Group takes no liability on behalf or for the contents expressed.

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