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Lessons from Nagaland on how to take healthcare to last mile


A new experiment was started in Nagaland some time back, which not only helped improve the otherwise ailing healthcare delivery system in the northeastern states but also emerged as a role model for other states to follow in terms of taking public healthcare to the last mile.

“We used a commoditisation policy in involving the community for management of healthcare. The administrative authority with regard to management of ANMs (Auxiliary Nurse Midwives) and sub-centres was delegated to the Village Health Committee, which works under the Village Development Board of Village Council that replaced the Panchayati Raj System in Nagaland,” said Abhishek Singh, Resident Commissioner, Government of Nagaland, while speaking at the recently-held 7th Healthcare Leaders Forum (HLF) in New Delhi.


The surprising lessons learnt from this experiment are of great value and can be emulated elsewhere in the country. “It was found that when the salaries of the ANMs and doctors of the primary health centres was paid by the community, their attendance as well as their contribution in managing healthcare at the last mile improved significantly than when it was managed by the Health Department,” said Singh.

This experiment was repeated in Nagaland not only in the healthcare sector but also in education and other fields.

“It resulted in remarkable improvement, and that’s the reason why Nagaland is much ahead in terms of averages for health parameters than the other states in the country,” added the Resident Commissioner, who has spearheaded many successful health programmes in the country.

Although the country’s healthcare system has made great strides in the last 15 years, there still remain many challenges to address, Singh believes.

“The life expectancy has increased by almost seven years; the mortality rate has come down by almost half; maternal mortality is down by 60 per cent; and the total fertility rate has come down to almost replacement level ratios. This all reflects the efforts being made in improving healthcare in the country. But if you look at the challenges, we register 27 per cent of all neo-natal deaths of the world despite having only 17.5 per cent of the world population. We also have 23 per cent of infant deaths and shortage of more than 500,000 doctors.”

Speaking on how technology can be leveraged for managing healthcare, he said, “We have two frontiers of technology which are making great impact by helping healthcare providers to make services more accessible and affordable.”

Singh pointed out that although telemedicine is a promising innovation to serve under-served areas, it still requires a doctor at the back-end.

According to him, to address this challenge Artificial Intelligence is being used. “For basic diagnostics and checking basic vitals, instead of going to a doctor, who are in short supply, automated software are being used for routine cases. These systems can even prescribe medicines.”

“Some software available in the market today enable patients to talk with chatbots, who in turn can get the basic data and then prescribe the medicine which is required in normal cases. It works fine where medical condition is not of serious nature. After going through the first few steps, if required, the patient can be referred to a specialist doctor,” he added.

Today, we have mobile apps like YourMd, which has been recognised by the NHS UK and being used commonly by patients and doctors in the UK.

The advances in natural language processing have made great strides and it is possible for patients in rural areas to talk in their local language with health specialists, Singh said.

“We also have apps like ADA, which works with Amazon Alexa and can help in getting basic data on the ailment and help the doctor in resolving that. There is a Bangalore-based company, which has created a unique AI-based engine that can analyse blood slides and give diagnostics report,” the Resident Commissioner observed.

Some companies have even built wearable patches. “It is like a wireless device that can be attached to the chest to monitor vitals and keep on transmitting the data on cloud storage, where analytics can be built in. It is estimated that AI-based apps will be the next big thing in the healthcare space,” he said.

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