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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.
There are 69 Private Hospitals in Assam
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1. Scatter Plot of per capita NSDP across States and availability of private hospitals per thousand population
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2. Scatter Plot of per capita NSDP across States and availability of private hospitals per thousand population
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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.
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3. Doctors in States of India per population of 1,00,000 people, as of 2018
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4. Doctors in States of India per population of 1,00,000 people, as of 2018 (NORTHEAST)
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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.
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Comprehensive description: Healthcare practices for women and children
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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.
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 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 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.
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.
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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.
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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
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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)
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)
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)
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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.
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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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