A slew of measures have been taken in Nagaland under the National Health Mission (NHM) to make healthcare facilities more accessible and affordable to every single citizen of the State, says Dr Kevichusa Medikhru, Mission Director, National Health Mission (NHM), Nagaland, in conversation with Elets News Network (ENN).
Q How do you perceive healthcare scenario in Nagaland in terms of affordability and accessibility?
Nagaland is the 16th State of India. However, due to limited resources, it is lagging behind other States of the country in most of the dimensions, including health. Despite the resource constrain, the State is trying its best to capitalise on the available resources which received a boost after National Health Mission (NHM) was implemented in the State in 2006.
Through NHM, the gaps in the infrastructure, HR, equipment, etc., have all been rooted out to a certain extent. Still, in terms of affordability and accessibility, it is one of the States with high OOPE (out of pocket expenditure), which can be attributed to various factors like shortage of medicines, absenteeism of healthcare facilitators including nurses and doctors, delay in healthseeking behaviour, shortage of referral transport vehicle, high transportation cost due to difficult terrain and so on.
Recently, to make healthcare more accessible, many health sub-centers have been set-up to deliver health services at the doorsteps. Existing health facilities have also been strengthened so that more people could access healthcare services in and around the area where they reside.
Q Tell us about the latest initiatives by the National Health Mission, Health & Family Welfare Department, Nagaland, to improve healthcare services delivery in the State.
New initiatives which have been initiated in the State under NHM during the past few years are as follows:
• Jan Aushadhi stores
• Pradhan Mantri National Free Dialysis Programme and Free Diagnostic Services Initiatives
• Electronic Vaccine Intelligence Network (eVIN) in collaboration with UNDP
• Universal health checkup/Screening and management of NCDs and referrals
District hospital strengthening through the provision of specialists, equipment and other technical HR as per requirement
• Provision of nutritional support to TB patients
• Ayushman Bharat-wherein Health & Wellness Centres are being set-up in the sub centers and PHC (Primary Healthcare)
• NHPM (National Health Protection Mission) which is now called PMRSSM (Pradhan Mantri Rashtriya Swasthya Suraksha Mission) will be rolled-out in the State very soon
Q Nagaland fares not so good in terms of key maternal and child healthcare indicators. What steps are being undertaken to improve the situation?
It is true that Nagaland is faring badly in most of the key reproductive, maternal, newborn, child, and adolescent health (RMNCHA) plus indicators. However, if the indicators of the last 10 years are analysed, it will be observed that improvement and progress have been made in terms of most of the indicators, though much more needs to be done.
Some of the steps undertaken to improve the scenario are as follows:
1. Adequate operational delivery points and FRUs (First Referral Unit):
Initiating measures for starting institutional/safe delivery in strategically located health units, so that 100 per cent of DHCs, CHCs and all 24X7 PHCs and at least 20 per cent of SCs conducts institutional delivery to mitigate the problem of high home delivery.
Operationalisation of 50 per cent of the existing health units conducting institutional delivery into fully functional delivery points conforming the Government of India criteria of delivery points.
2. Strengthen Village Health Nutrition Day and outreach activities for optimum service delivery with quality; coupled with comprehensive IEC/BCC activities:
• Intensifying Village Health and Nutrition Day (VHND) so that every Village/Town/Habitat without a doctor will be accessible to comprehensive services under the supervision of a doctor at least once in a month.
• Integrated approach of Mobile Medical Units (MMU) and Mobile ICTCs for delivery of comprehensive services.
• Strengthening Referral Transport System to bridge the demand gap with expected outcome in reducing OOPE by beneficiaries.
• Ensure and strengthen delivery of home-based care through quality training and orientation. • Initiate NCD screening activity for a comprehensive service delivery.
• Honing skills of service providers through rollout and implementation of Dakshata programme and LaQshya.
• Expanding the service package including locally endemic problems viz: HIV affected children.
• Strengthening of MCTS, MDR, tracking of Anaemic Pregnant Women and introduction of CDR.
• Expansion of service delivery through regular implementation of Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA).
Q What kind of challenges are you facing to implement Centre’s Ayushman Bharat National Health Protection Mission?
The NHPM is now renamed as PMRSSM. Right now, enrollment process as per SECC data is going on. A few challenges that are being faced at the moment on the implementation front include poor internet connectivity wherein the data has to be downloaded from the portal. There are reports from the grassroots level that SECC data does not cover the entire BPL population of the State and for which genuine beneficiaries may be even left out.
Q North Eastern states including Nagaland are facing a shortage of trained medical manpower. What is being planned on this front?
To resolve the issues relating to shortage of trained medical manpower, the State has initiated the following strategies:
• Optimising the efficiency of the available workforce by further integration and multi-tasking.
• Positioning adequate human resource by rational deployment and creation of adequate critical posts.
• Expedite the establishment of medical college to address the issue of acute manpower shortage and delivery of tertiary care.
• Strengthening of nursing schools for quality skill development.
• Upgrading PMTI to provide critical paramedical courses.
• Expedite the functioning of the existing SHFWTC.
• In-service skill development.
• Selection of local resident candidate, particularly for undergoing ANM/ Paramedical Courses.
Incentive Schemes; facility-based group incentives.
• Additional remuneration based on difficulty of health units across districts/blocks.
• Provisioning PG study based on length of service and rural posting.
• Vocation incentive for practicing multi-skilled doctors on LSAS and EmOC.