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Towards a Resilient Health System in NE

by Rinku Khumukcham
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By: Ms. Pumani Kalita, Dr. Joydeep Das, Dr. Ashoke Roy
The North Eastern Region of India signifies a distinct geographic, cultural, politicaland ecological entity. Although characterised by diverse social structures, geographical andtopographical features, with a mix of hills and plains, multi-faceted ethnic and cultural heritages, this region offers unique challenges for development. Even so, an all-round development of the region remains a priority forthe Government under the leadership of Hon’ble Prime Minister, Narendra Modi. Upholding the mantra ‘SabkaSaath, Sabka Vikas, Sabka Vishwas’ the Prime Minister says “I see no reason why the North East region of the country cannot develop.”
This region had been struggling with poor health indicators, owing to inadequate infrastructure, limited manpower, inaccessibility,and difficult communication. With the launch of National Health Mission in 2005,a community namely ‘Accredited Social Health Activist’(ASHA)was introduced. When permanent solutions to the long withstanding challenges of inaccessibility were still a distant dream, ASHAs became the first port of call for the community, bridging the gap between people and the health services. The 55,000+ ASHAs in NE States have not only provided basic care to the community but also prepared people for their health rights. They did a splendid workin mobilising the community during the pandemic. When the region is burdened with the load of rising non-communicable diseases like the rest of the country, ASHAs once again became an integral part of the battle. Making the community aware about such diseases andthe risk behaviours, lifestyle modifications, wellness activities like yoga, mobilising the people for screening for such conditions etc. being a part of the referral and follow-up mechanism for treatment adherence of the beneficiaries are some of the worth mentioning areas where ASHAs have been putting in their efforts.
Over last eight years, the region has achieved significant advancement in creating new health paradigm.During the post–budget webinar on ‘Health Sector’, Hon’ble PM stated,”I have been talking about ‘One Earth One Health’. With the same spirit, we must develop ‘One India One Health’ in India too. This mission is also similar, i.e., the same healthcare facilities should be developed in remote areas too. We must strive to ensure that critical healthcare facilities are present at the block level, the district level as well as in the villages”. 
With this as a driving force, the paradigm shift is being observed in health sector in recent years in the form of additional allocation of around Rs. 1,14,323 croreexclusivelyfor health sector under 15th Finance Commission and Pradhan Mantri Ayushman-Bharat Health Infrastructure Mission (PM-AB-HIM) grants for strengthening HWCs,Diagnostic Services Network, Critical Care Blocks in all districts, infrastructure, and more.
Across the NE States, 16Medical Colleges have been established till 2021 and few more are in the pipeline. Remarkable efforts have been put-in for equipping the health services with quality human resources by authorising enhanced annual intake.
Serving the community with better health care services has not been limited at developing infrastructure and engaging more doctors & nurses alone.A relief to the people also came with launch of Free Diagnostic Services Initiatives (FDSI) for both APL and BPL families with free laboratory tests, CT scan & X-ray services.
The dream of Free Dialysis Services came true with the launch ofPradhan Mantri National Dialysis Programme (PMNDP) in 2016,and since then, nearly two lakh free hemo-dialysis sessions have been availed by patients in 59 districts of the region.
With the launch of Ayushman-Bharat Health & Wellness Centre (AB-HWC) on April 14, 2018, primary health care services have been brought closer to the community. Since then, many HWCs have been set up providing wide range of services, including free treatment, rehabilitate and palliative care for the elderly and terminally ill patients and various wellness activities. With the aim of providing free access to health insurance coverage for the low income earners, free secondary health care for those needing specialist treatments and tertiary health care for those requiring hospitalisation, the Ayushman-Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY) was launched by the Government. The scheme was initiated as a fight against the out-of-pocket expenditure which pushesmany below the povertyline.
In recent years, quality services have always been a priority in the public health system. Promoting cleanliness, hygiene and infection control practices in public health institutes were the aims when Kayakalp was launched in 2014. The State of Mizoram has been privileged to be one of the first public health institutes in the country that aims at improved delivery of quality services. To achieve the long-term goal of reducing maternal and infant death, care around birth has been identified as one of the strategic actions and a total of 15public health institutes, 9/14 are in aspirational districts, have had its labour room andoperation theatre quality certified.
During the COVID-19 pandemic, the region further strengthenedthe health care service delivery with commissioning of new field hospitals and additional beds, new ICUs and pediatric ICUs with ventilators and strengthening the diagnostic facilities. Most of the District hospitals now have Oxygen Generation Plants which were not there earlier. Rapid training of frontline workers including ASHAs and building partnerships with local leaders, community engagement helped a great extent.
Over last few years the public health services have undergone tremendous reform and have been brought closer to the community. This is evident in the region as it achieved significant breakthroughs, a few to mention- decreasing trend in maternal deaths (Assam) and infant deaths – four states (Manipur, Mizoram, Nagaland and Sikkim) out of eight NE states are having single digit Infant Mortality Rate (IMR), increased institutional deliveries, improved family planning services, prevention and management of seasonal diseases etc.
North-East is diverse, so are its challenges. Behind the picturesque beauty there exist numerous barriers to development. Nonetheless, constant progresses made over the years testify that sincere efforts and commitment can make public health care services better for the community. With such remarkable changes at the grassroots, this region is witnessing the dream of a resilient health system coming true in near future, upholding the mantra ‘SabkaSaath, Sabka Vikas, Sabka Vishwas’in true sense.

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