Mr. Vincent H Pala (MP: Shillong, Meghalaya)
Pankhuri Jain (LAMP Fellow)
Nidhi Agarwal (Assistant Director, FICCI)
Meghalaya, a state that is taking huge strides and gaining wide recognition for high ranking in the start-up ecosystem, the top rating in Niti Aayog’s innovation index suffers largely on the healthcare services front, particularly for the delivery of healthcare services. The shortage of doctors places tremendous pressure on the health care system where one doctor is required to attend to 5,500 residents. In addition to a paucity of resources in government hospitals, accessibility to healthcare services is also a huge barrier due to the location of certain primary healthcare services and hospitals in remote areas where roads don’t allow for travel. Very recently, there was a story on how villagers carried a pregnant lady on a bamboo shift when the vehicle could not reach her so that she could deliver her baby in a hospital.
Poor healthcare infrastructure is a stark reality that should be acknowledged and measures should be taken to build a healthy state. According to the ‘Healthy States, Progressive India’ report by the NITI Aayog, Meghalaya is the second worst performing state in terms of institutional deliveries in the entire northeastern region. The state not only witnesses low institutional deliveries but also a very high Infant Mortality Rate (IMR). According to NFHS-5 (National Family Health Survey) Report, the infant mortality rate is estimated at 32 deaths before the age of one year per 1,000 live births, more than the NFHS-4 estimate of 30 deaths. In addition to this, children’s nutritional status has not seen major improvement when compared to NFHS-4 data. Though the prevalence of stunting (among children under the age of five years) has reduced to some percentage points between 2006 and 2016, it continues to remain higher than India’s average of 38.4%. The percentage of children underweight (27%) or wasted (12%) has only marginally declined since NFHS-4. The continuing high levels of undernutrition remain a major problem in Meghalaya.
The rate of exclusive breastfeeding (EBF) is also very low as compared to the national average (almost 20% lesser than the Indian average of 54.9%). Maternal care too is an area of concern. Only 9% of children received a health check within two days of birth and 47.5% of mothers received postnatal care within two days of delivery which is way below the national averages.
In line with the MOTHER app, which is used to collect primary data on pregnant women by medical officers and health functionaries and the data collected is used to be able to track high-risk pregnancies which can greatly reduce mortality cases. To further the reach and the impact of this initiative, ASHA and Auxiliary Nurse Midwives and the involvement of Self Help Groups can serve to strengthen healthcare by generating awareness by conducting programs in remote areas on good health practices and improving behaviors for availing timely health guidance from public health institutions. The training could focus on issues of stunting, malnutrition, and micronutrient deficiencies that occur due to malpractices. Thus, training of ASHA workers, Auxiliary Nurse Midwives, and the involvement of Self Help Groups is very critical in ensuring the dissemination of the correct knowledge and best health practices. Data collected by these community workers could be updated on apps such as the MOTHER app which would also facilitate the state government and the central government on the welfare of the people and what interventions would be beneficial based on the real-time needs of the people.
It is imperative for the government to address the inadequacies of the existing healthcare infrastructure, particularly the shortage of healthcare professionals as the public healthcare services provide the majority of the services to the people of Meghalaya. Apart from the challenges discussed above, Meghalaya has its unique challenges which must be taken into consideration to build a robust healthcare infrastructure.