Healthcare in Assam

Healthcare in Assam needs a serious upgrade

Highlighting healthcare disparities in Northeast India, our analysis reveals a critical need for systemic improvements, spanning from infrastructure to personnel, to address pressing issues in public and private healthcare.

Healthcare Disparity in Northeast India

There are 69 Private Hospitals in Assam

Private Hospitals in Kamrup District
Private Hospitals in Other Districts of Assam

Only 49 Hospitals

Data from IIB India shows hospitals in other North Eastern states

510 Private Hospitals in New Delhi

Data from IIB India shows hospitals in other states

5 Crore Population of North East states

National Commission on Population, MoHFW, 2020

With only 67 hospitals serving this large population, there are approximately 0.13 hospitals for every 1,00,000 people, which is alarmingly low!

Distribution of Private Hospitals Empanelled
by Insurance Companies

1. Scatter Plot of per capita NSDP across States and availability of private hospitals per thousand population

District-wise Private Hospitals Empanelled by Insurance Companies per lakh population

2. Scatter Plot of per capita NSDP across States and availability of private hospitals per thousand population

Sources: National Institute of Public Finance and Policy 2019
Note: Kerala has been excluded from the above as it is an outlier. The availability in Kerala is multiple times more than all other States.

Assam - Key Indicators

The State of Healthcare in India

As per information provided by National Medical Commission (NMC), there are 13,08,009 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) as on June, 2022. Assuming 80% availability of registered allopathic doctors and 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is 1:834 which is better than the WHO standard of 1:1000. Also, there are 34.33 lakh registered nursing personnel and 13 lakh Allied and Healthcare Professionals in the country.

Medical Professionals in India

34 Lakhs

Nursing Personnel

13 Lakhs

Allopathic Doctors

5.6 Lakhs

AYUSH Doctors

1. Nurses in States of India per population of 1,00,000 people, as of 2020

2. Nurses in States of India per population of 1,00,000 people, as of 2020 (NORTHEAST)

Sources: Press Information Bureau (Government of India, MoHFW), National Medical CommissionNotes: Data was not found for the following states/UTs: Nagaland, Ladakh, A&N Islands, Chandigarh, D&N Haveli and Daman & Diu, Lakshadweep, Puducherry, Jammu & Kashmir

3. Doctors in States of India per population of 1,00,000 people, as of 2018

4. Doctors in States of India per population of 1,00,000 people, as of 2018 (NORTHEAST)

District-wise Private Hospitals Empanelled by Insurance Companies per lakh population

Sources: Press Information Bureau (Government of India, MoHFW), Central Bureau of Health IntelligenceNotes: Data was not found for the following states/UTs: Manipur, Ladakh, Puducherry, D&N Haveli, Daman & Diu, Chandigarh, Delhi, A&N Islands, Lakshadweep.

The urgent need to transform healthcare

Limited Access and High Costs:

Public: The public health care system in rural areas of Morigaon, Assam, is in a poor state, leading to impoverished households relying on costly private-sector health care services. The region is facing an epidemiological and demographic transition, with an increased burden of chronic diseases and a significant number of people living with HIV/AIDS. Non-communicable diseases, such as cardiovascular diseases, cancer, mental illnesses, and tobacco-related illnesses, are straining the already over-stretched health care system. The lack of public spending on preventive health services and the high proportion of private spending on health make health care unaffordable for many in Morigaon. The private health care sector is unregulated, contributing to higher health care costs for the rural poor. Additionally, issues like malnutrition, anemia, inadequate safe drinking water, sanitation problems, and waste disposal pose major challenges for the public health system in Morigaon. To address these multiple health crises and improve the quality of health services, urgent action is needed to transform the public health system in Morigaon, making it accountable, accessible, and affordable.

Private: There are several private hospitals and clinics in Morigaon district that   provide general medicine services to the local population. These facilities may provide a range of services, from basic outpatient care to specialized medical care.

Charity: There are no charity hospitals in Morigaon district.

1. Doctors at PHCs in India per a population of 1,00,000 as of 2021

2. Doctors at PHCs in India per a population of 1,00,000 as of 2021 (NORTHEAST)

3. Nurses at PHCs in India per a population of 1,00,000 as of 2021

4. Doctors at PHCs in India per a population of 1,00,000 as of 2021 (NORTHEAST)

Source: Rural Health Statistics 2020-21 (Government of India, MoHFW Welfare Statistics Division, 2022)
Notes: Telangana came to existence in 2014 after bifurcation of Andhra Pradesh. Jammu & Kashmir and Ladakh bifurcated and became UTs during Aug 2019. Dadra & Nagar Haveli and Daman Diu merged as single UT during Jan 2020. No data for Chandigarh.

Healthcare Facilities in Assam Districts

Private Hospital Distribution by department

Healthcare for Women & Children in Assam: Initiatives & Challenges

Comprehensive description: Healthcare practices for women and children

Maternal Healthcare:

Maternal healthcare in Assam has been a focus area to reduce maternal mortality and improve the health of pregnant women. The state government and various organizations have launched programs to increase awareness about prenatal care, institutional deliveries, and antenatal check-ups. These initiatives aim to ensure that pregnant women receive regular medical attention, proper nutrition, and counseling to reduce the risk of complications during pregnancy and childbirth.

Janani Suraksha Yojana:

The Janani Suraksha Yojana is a centrally sponsored scheme implemented in Assam to promote institutional deliveries. Under this program, pregnant women, especially those from low-income families, are incentivized to give birth in healthcare facilities. Financial assistance and benefits are provided to women to encourage them to access skilled delivery services, which can lead to better maternal and neonatal outcomes.

Neonatal Care:

Neonatal care is crucial in Assam, where the infant mortality rate has been a concern. Specialized neonatal care units and trained healthcare professionals focus on providing intensive care to premature and critically ill newborns. Ensuring access to neonatal care facilities and skilled health workers can significantly improve survival rates for newborns in the state.

Reproductive Healthcare:

Reproductive healthcare services in Assam focus on family planning, maternal health, and sexual health education. Availability of contraceptives and family planning methods, along with awareness campaigns, empower women to make informed choices about their reproductive health.

Choosing Between Public and Private Healthcare in India's North-East

Understanding Perceptions and Preferences:

According to WHO (2010), a people-centered health system should prioritize meeting the population's needs and expectations, including improving health status, defending against health threats, providing financial protection, ensuring equitable access, and involving people in decision making. Proper monitoring and evaluation are essential for identifying strengths and weaknesses in the sector (Hossain, 2015).To achieve equitable access to health, sufficient health resources like infrastructure, skilled medical practitioners, and medical supplies are necessary, considering health outcomes, diseases, socioeconomic factors, and geography (Baru et al., 2010; Kiadaliri et al., 2011; Aremu et al., 2011; WHO, 2019).

Studies show a growing prevalence of untreated morbidities, particularly among India's rural population. Many undiagnosed, unreported, and undertreated cases, especially among the illiterate and financially weaker sections, may be due to increasing medicine costs and treatment expenses (Ghosh and Arokiasamy, 2010; Ghosh, 2014a; Pandey et al., 2017; Anushree and Madheswaran, 2018).

The Rural Health Statistics Report (2018-19) highlights a significant disparity in health facilities and human resources at primary health centers (PHCs) and community health centers (CHCs) in tribal areas within the 8 states of the North-East Region (NER), which are predominantly populated by tribes. This shortage of human resources is particularly prominent and serves as one of the primary reasons why rural women and men resort to seeking private healthcare, leading to higher healthcare expenses.

In the NE region, private healthcare is the preferred choice for treatment by a majority of people (54%) compared to public healthcare facilities (47%). This preference becomes more apparent when examining the specific ailments for which treatment is sought. Interestingly, despite public healthcare being the primary provider in most states, a significant rural-urban disparity exists in terms of the preferred facility for treatment, and this choice varies based on the nature of the ailments.

The reasons behind people opting not to choose public healthcare for treatment have been grouped into several categories: (a) Unavailability of services, (b) Dissatisfaction with the service quality, (c) Facility location being far away or long waiting times, (d) Preference for different doctors or facilities, and (e) Other reasons. These reasons have been analyzed in the context of specific diseases to better understand people's perceptions regarding the capability, expectations, and quality of public healthcare for treating various ailments, including life-threatening diseases.

Source: Disease Burden and Healthcare Utilization in the North Eastern Region of India (Manali Swargiary and H. Lhungdim 2021)

Reasons for Not Opting for Public Healthcare



Infectious Diseases: The primary concerns are long distances and extended waiting times


Infectious Diseases perceived poorer services & Preference for different doctors/facilities


Non-Communicable diseases (NCDs): The main reasons for not being satisfied with healthcare service

Source: Disease Burden and Healthcare Utilization in the North Eastern Region of India (Manali Swargiary and H. Lhungdim 2021)

Health Challenges in Assam:
Women's Nutrition and Child Health at Risk

Only 8.9%

Of children during the first two years of their lives received an adequate diet. Leading to high incidence of infant mortality rate and nutritional deficiency in Assam.


Of women in Assam have below-normal BMI

The low BMI and anemic conditions  amongst women in Assam contribute towards reinforcing ‘structural deficiency’ in child health


Children in the state with stunted growth (NFHS-4)

Adequate breastfeeding & supplementary diet for children has decreased to 49% in 2015 (NFHS-4) compared to 60.1% in 20015 (NFHS-3) in the state


Anaemia was prevalent in pregnant women and 69% of women who were not pregnant


Teenagers pregnancy (15-19 years age group) and 13.6% of them were already mothers

Source: Saswati Choudhury, 2020

Analysis: Institutional Health Care

While establishing direct causation may be challenging, a clear correlation exists in Assam's healthcare landscape. A study of 62 hospitals in the region reveals a significant disparity: while 46.7% of these hospitals boast Obstetrics and Gynaecology departments, a mere 14.5% of them are equipped with Post Maternal, Neonatal, and Critical Care units. This unsettling discrepancy indicates that while there are facilities available for women's health, including delivery and various gynecological procedures, the provision of critical care services in cases of complications remains deficient. This scarcity of intensive care facilities is not confined to women alone but extends to children, particularly those born prematurely or as newborns. Such inadequacies may well contribute to the alarming rates of maternal and infant mortality in Assam. In addition to the shortcomings within the population in terms of safety and healthcare, the issues with institutional healthcare may be further attributed towards this problem.
The impact of this shortfall is evident in the region's maternal and infant mortality rates. The lack of comprehensive intensive care facilities might exacerbate medical complications during childbirth and the delicate phase of neonatal care, leading to tragic outcomes that could otherwise be preventable. In addition, research conducted in rural Assam, reveals that despite the expansion of institutional deliveries, childbirth experiences in government facilities involve obstetric violence. Poor and indigenous women, who rely disproportionately on state facilities, report both physical and emotional abuse during labour, including iatrogenic procedures without anaesthesia, improper pelvic examinations, beatings, and verbal abuse. While increasing access to emergency obstetric care can lower maternal mortality, the absence of humane care during labour perpetuates a paradox where "safe" births coexist with violent practices, highlighting the complex and unequal relationship between the poor and reproductive governance. Limited access to antenatal and postnatal care, skilled birth attendants, and essential healthcare services during pregnancy and early childhood contribute to higher maternal and child mortality rates. (Chattopadhyay, 2018)

Addressing Maternal Health and Child Nutrition

The Road Ahead in Assam:

According to the reports of 17 of the country’s states, the country's health department has faced a significant failure, drawing widespread concern from conscious citizens, particularly in Assam. The state's maternity health problem has come under intense scrutiny due to its alarming Maternal Mortality Rate (MMR), which currently stands as the highest in the country. The Registrar General's Office released a report (2018-20) revealing distressing figures, further exacerbating the worries among the people of Assam. According to the data, Assam holds the unfortunate distinction of having the highest incidence of premature maternal deaths compared to all other states, with a Maternal Mortality Rate of 195 cases per one lakh live births. (Kalita, 2022)

Highest maternal mortality rate

4th highest infant mortality rates

Maternal Health Challenges in Assam

A Call for Urgent Healthcare Reforms:

The cause of unexpected maternal deaths, particularly in poor families in the sar areas of Assam, is attributed to malnutrition during pregnancy. This leads to a notable number of maternal anemia cases in the state, hindering the normal process of childbearing and childbirth. Lack of access to necessary treatment during pregnancy and inadequate medical assistance further contribute to the problem. The National Family Health Survey (NFHS) highlights a concerning prevalence of anemia among women and children in Assam, surpassing several other states in India. This alarming situation not only reflects the poor social status of women but also sheds light on the overall neglect and deprivation they face in various aspects of life, including education and culture. Despite advancements in science and technology, women in these areas continue to struggle for their rights, emphasizing the ongoing challenges they endure.

In these areas, some men resist family planning despite health department awareness meetings explaining the risks of having more than two children for maternal health. According to available data, there is a shortage of gynecologists, child specialists, surgeons in over 50% of the country's community health centers. Additionally, 30% of primary health centers lack female ANMs. The state health department advises waiting three to four years after the first child for the second, but this advice goes unheeded. To reduce the Maternal Mortality Rate, our country urgently needs to address this shortage and recruit an adequate number of gynecologists, child specialists, surgeons, nurses, and ANMs in hospitals and health centers. (Nath, 2022)

A Case in a PHC of Assam

Healthcare Challenges in Sontoli Mini PHC, Assam

In the heart of Assam's Kamrup district lies the Sontoli mini Primary Health Centre (PHC), providing essential medical care to approximately 1.75 lakh residents since its inauguration in 1974 by former President Fakhruddin Ali Ahmed.However, a critical issue plagues this healthcare center - the absence of an obstetrician. Despite this, the PHC witnesses an average of ten daily childbirths, serving as the sole healthcare facility for the remote Chars community, about 80 km from Guwahati, the capital city of Assam.Transporting patients from the Chars to the PHC poses a unique challenge, relying on mechanized country boats across the Brahmaputra river, followed by a three-kilometer journey to the PHC. The lack of an ambulance compounds the urgency during medical emergencies. While fortunate to receive an ambulance in 2007, the vehicle has deteriorated after covering approximately 4 lakh km and remains non-functional since 2015. This leaves patients and attendants with harrowing experiences in their pursuit of urgent medical care. (Talukdar, 2017)


In conclusion, the pressing issue of women's healthcare not being a priority has significant implications for infant mortality rates. The process of infant mortality begins right from conception and is closely tied to the overall physical health of the mother. The critical cases we receive from the peripheries underscore the urgent need for strengthening community medicine and bolstering gynecology and pediatric divisions in hospitals. However, a concerning trend persists where women do not consult doctors during their pregnancies, often due to financial constraints or relying on traditional medicine. The lack of regular medical consultations during pregnancy highlights the importance of raising awareness about the significance of prenatal care. By addressing these challenges and empowering women to prioritize their health throughout pregnancy, we can take significant strides towards reducing infant mortality and fostering healthier outcomes for both mothers and their precious newborns.

Collaborated by: 

Tanvi Sardana

Business Insights Analyst

She is a final-year Math Major at the University of Delhi. She's interested in Analytics and building Models that can drive growth and create a difference within organizations. She's always interested in talking about books, cultural movements of the 70s, and exploring new places.


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