World Health Day is observed on April 7 every year as a campaign to maintain focus on health. This day commemorates the establishment of WHO (World Health Organisation). Marking the 75th year of WHO's inception, the theme this year is " Health for All".
Using data visualizations as a tool, this is an attempt to provide a descriptive analysis of the Health Sector of Meghalaya. Meghalaya is predominantly a rural state with almost 80.4 percent rural population. Of the total population of Meghalaya i.e., 2,318,822, 86.1 percent is Scheduled Tribes. The ethnic groups ‘Khasi, Gharo, and Jantia’ and many similar smaller communities are its natural inhabitants.
Health Infrastructure in Rural and Tribal Area:
I refer to the NHFS 5 (National Family Health Survey 5) and Rural Health Statistics data (as of March 31, 2021) here. Under Rural Health Mission, a three-tier system is followed in India. The Sub-Centers, Primary Health Centres, and Community Health Centres form these three tiers.
There are substantial SCs in rural and tribal areas, as shown in Figure 1, but they are peripheral services with no qualified doctor. I want to draw attention to the 28 CHCs catering to the medical needs of the 1,864,711 rural population in Meghalaya. Technically, only the CHCs are equipped with specialists and paramedical facilities. Considering this region's rugged terrain and scattered settlements, one wonders if they can be any significant relief. More functional CHCs and better-equipped Sub Centres could give a brighter picture. Since there is already a well-oiled system at the very first level, capacity building and regular training to upskill the health workers can help.
Figure 1: Functional Health Centres in Meghalaya as of 31st March 2021
And I say this because the sub-centers form the most peripheral and first contact point between the primary health care system and the community. PHC, the Public Health Centre, is the first contact point between the village community and the medical officer. They provide mere curative, preventive, promotive, and family welfare services. The CHCs are mandated to have medical specialists, are supported by paramedical staff, and are well-equipped. The pyramid below provides an ample description of the functionalities of CHCs and PHCs.
Population Norms for Health Care Infrastructure: Identifying the Gaps
Figure 2 shows the functional healthcare centers catering to the population across the country. Though the number of Sub Centres available for the population is decently placed compared to the national scenario, the available CHC here is amongst the lowest. It cannot be ignored that SCs do not have any doctors or other medical facilities like pharmacies, testing labs of any kind, or even a bed for patients. Health workers/ ANM are all that is available there. And these facilities are for 80.4% (1,864,711) of the total population of Meghalaya (2,318,822).
Figure 2: The average rural population (mid-year population as of 1st July 2021) as of March 2021
On the first instance, the spread of health infrastructure against the population norms set by the Government gives a positive feel. There is functional SC for every 5000-7000 people in rural/tribal regions, 1 PHC for 20,000-30,000 population, and 1 CHC for up to 100,000 population in rural Meghalaya. Look at
Table 1: The healthcare facility available: the standard population norms vs average rural population (mid-year population as of 1st July 2021) as of March 2021 in Meghalaya
|
Centre |
Population Norms* |
Population Coverage in Rural Meghalaya** | |
|
Plain Areas |
Hilly/Tribal/Difficult Area | ||
|
Sub Centre |
5000 |
3000 |
5000-7000 |
|
Primary Health Centre |
30000 |
20000 |
20000-30000 |
|
Community Health Centre |
120000 |
80000 |
0-100000 |
*Number of persons covered under the services of a particular Facility (SC, PHC & CHC)
** The average rural population (mid-year population as of 1st July 2021) covered by centers as of March 2021
Healthcare Professionals:
The Tribal Region:
No specialist at any of the 28 CHCs and only 1 physician says it all. The story of the health and well-being facility provided to the treasured tribal community in this land of 'Shyllong'*** seeks action, not words. The shortage of paramedical staff is significant. Evident as it is, female health workers run the rural health system here. Remember, the rural health system is the responsibility of the state government. Check out these gaps in Figure 4 below
Figure 4: Healthcare Professionals in Tribal area: In-Position vs Required numbers.
The Rural-Urban Divide:
It would be unfair to overlook the rural-urban divide for the spread of medical facilities, especially if the intention is to look at the plugin areas to achieve ‘Health for All’. The situation is similar in both rural and urban Meghalaya. With only three specialists, the ground reality is grim. The paramedical expertise is also way below the recommended mark. See for yourself the visualization in Figure 5
Figure 5: Healthcare Professionals in rural and urban areas: In-Position vs Required Numbers
The latest health manpower, as of March 2023, shows 267 specialists but does not specify how many are placed in the rural/tribal regions. Incidentally, Meghalaya has only one government medical college, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, established in 2008, and 16 District Hospitals. There is no private medical college.
Table 2: Health Manpower In-Position in Meghalaya as of March 2023
|
General Duty Doctors & Common duty doctors |
673 |
|
Specialists |
287 |
|
Dental Surgeons |
71 |
|
Ayush Physicians |
26 |
|
Staff Nurses |
1246 |
|
ANMs |
938 |
Medical Health Insurance:
Moving to health insurance, the status is encouraging. There is a marked shift in households taking health insurance in five years from 2014-15 to 2019-20. Figure 6 shows the distribution at the district level.
Figure 6: Health Insurance Coverage of Households by State/UT Percentage of households with at least one member covered by a health scheme or health insurance.
Figure 7: Percentage of households with at least one member covered by a health scheme or health insurance.
On the health insurance front, at the National level, Meghalaya is among the top-performing states at 6th position in pan Indian ranking, even above the national percentage. Look at the data from NFHS-5 for 2020-21. Figure 7 below is from the report.
The state has a rural population higher than the all-India figures of 72.2 per cent. Overall, hospitals are spread to cover as many districts as possible. And the State Health Mission set up under the Chief Minister oversees the implementation of the NRHM. But the land's topography makes the task challenging. Putting infrastructure alone does not mean the system is solving the purpose. Skilled manpower is equally, if not more, crucial. Having trained human resources in the rural belt is a challenge. The health workers deployed at Sub Centres may be upskilled with regular capacity-building initiatives designed for them. For the specialists, the incentives must be lucrative, or the mindset must be of an activist to get trained dedicated human resources in rural areas. Policy changes must be implemented to meet the challenge of getting trained medical specialists in rural areas. Only a robust Rural Health Infrastructure and qualified healthcare staff deployment on a mission mode can help achieve 'Health for All'. And so is true for Meghalaya.
References:
https://megplanning.gov.in/MSDR/rural_development.pdf
https://tribal.nic.in/ST/Statistics8518.pdf
***https://www.ohmeghalaya.com/u-lum-shyllong/