Public health and health care in Assam

By Dr Susmita Priyadarshini

In 2013, while iugurating the 102 tiol Ambulance Service and Tele Radiology Project, Union Health Minister Ghulam bi Azad lauded Assam Government's initiative as it emerged as a role model in the country by implementing highest number of schemes under the NRHM. The State really deserved that praise. Assam was one of the pioneers in undertaking several revolutiory initiatives in Public Health and Health Care. Even in case of Tele Radiology Project, Assam was the first in the country to initiate the project under the NRHM. This project bears significance due to the increasing cases of cancer in Assam. Assam is a pioneer State in the country to ect Assam Public Health Act that seeks to guarantee people's right to appropriate and efficacious health care, especially towards effective measures of prevention, treatment and control of epidemic and endemic diseases. The Act came into effect from January, 2011. Then Health Minister Dr. Sarma proudly said – "this is a historic bill, we are the pioneers in the country after the Centre requested all the states to bring a law on the right to health" .

The act makes it mandatory for all hospitals both government and private, including nursing homes to provide free health care services maintaining appropriate protocol of treatment for first 24 hours to an emergency patient of any kind. As a result who were once uble to afford costly medical treatment in private hospital and scared to go there can now go there in emergency. Policies like Majoni, Mamoni came even before the ectment of Assam Public Health Act 2010. This happens because Assam is one of the pioneers in starting gender budgeting. Gender budgeting came into tiol context in 2005 and Assam started gender budgeting from the fincial year 2008-09. Assam started emergency helpline in 2010. Assam is the second Indian state after Andhra Pradesh to have this call-a-doctor facility. The innovative and highly successful concept of rural Health Practitioners for delivery of trained and safe health care services in the rural world of Assam drew accolades from several quarters of the country. It inspired the Centre to think seriously to create an army of Bachelor of Rural Health Care. Perhaps even the arch rival of the Government will also admit the utility of the scheme like Sneha Sparsha which covers various health care initiatives such as monetary assistance for Liver transplant and leukaemia treatment for children below 12 years. Despite all these good attempts, the present Government is criticised for taking credit of all these Central government schemes. This is of course true. But by being one of the forerunners in implementing these policies it has proved its intention of doing something good for the people. But the spirit does not always remain the same. Take one example. Setting a record of sorts, the Health Department of Assam recruited 269 specialist doctors for 6 medical colleges and rural health centres in just two days in the current year. But same posts had been lying vacant for several years. Again, neither the public health nor the health department has remained scam free. Towards the last part of Dr. Sarma's tenure, fake appointment scam of grade III and IV employees in the Health Department of Jorhat district rocked the State. The Chief Minister's vigilance cell detected gross irregularities in the appointment of 84 employees during 2010-13. Besides, State has failed to achieve some public health goals despite having both the knowledge and expertise. It has failed to control even the vaccine preventable diseases like Japanese encephalitis. In 2014, 51% of the total cases of encephalitis in India was reported from Assam. What is noteworthy is that Assam was the first state in the country to start a JE Adult vaccition programme and the pilot project for it was undertaken in Sivasagar in 2011. But the Government's laxity combined with the dearth of rare vaccine failed to deliver result. TB control program cannot become successful if nutrition, life style and social environment are not given importance. 17% tea garden workers in Assam have tuberculosis. DOTs was launched in Assam in 2004. Recent incident of burning down of TB medicines at Tamulikuchi State Treatment Centre proves how seriously this program is being taken by the concerned people. These TB drugs are still beyond the reach of people in some areas of Assam. Boat clinic which is providing health services in char areas such as immunizations and vaccition, pretal and post tal care for pregnt women, malaria intervention, Japanese Encephalitis intervention, apart from general health check ups is in fact the brainchild of Sanjay Hazarika, maging trustee of the Centre for NE Studies and Policy Research. In 2005, the Ministry of Health and Family Welfare launched the Jani Surakasha Yoja, a cash transfer programme to reduce materl deaths. Besides cash transfer it makes provision to reduce out of pocket expenditure.

But one thing remains untouched that is medical intervention in cases of accidents during pregncy. State Government could have bridged this gap through insurance coverage. There is scarcity of medicines in Government hospitals. Instead of getting free medicines patients are to purchase everything from bandage, saline to medicines. Though the papers show huge purchase of medicines by the Health Department and NRHM for the years 2013-14, 2014-15 where do these medicines go nobody knows. District hospitals still lack special care units, medicines and laboratories to deal with any epidemic. Recent outbreak of Dengue in Delhi has already proved that to check the spread of any disease a functiol public health care system is required. The Government of Assam sent a proposal to set up an AIIMS in the state long ago in 2001. Though the project was filly included in the current fincial year Union budget, yet the site has not been filized. While signing a MOU with raya Hrudalaya Hospitals PVT. Ltd, Bangalore in 2012 then Health Minister Dr. Sarma said that Assam would emerge as a health hub for the region. His dream did not materialize and every year a good many number of patients have to go to Mumbai, Cheni and Delhi for the treatment of critical diseases. One important aspect of public health has failed to get importance i.e., biomedical waste magement. Public health being the a state subject, it is the primary responsibility of the concerned state/UT governments to take appropriate actions for proper magement and disposal of bio medical waste at public health facilities through the State Pollution Control Board in pursuance of Biomedical Waste (Magement and Handling) Rules, of Ministry of Environment and Forest. There is absence of appropriate mechanism for disposing of medical waste generated in most of the health institutions in the State. It is largely done through indiscrimite burning causing serious health and environmental implications. Infectious liquid waste is often released into the common sewage pipes without any treatment, ignoring the fact that mixing of untreated liquid waste with common sewage can cause contamition of ground water sources like Wells, tanks, even bore wells and adversely affect all life forms. During Dr. Sarma's tenure, three new medical colleges were established. But even in medical colleges proper waste magement facility has not been established yet. Take the case of Jorhat Medical College. Incinerator is not in running condition. Number of dustbins placed at different places for waste collection is not sufficient. Even today, dumping of both general and medical waste is seen outside the front wall of the JMC. There is only one Common Biological Treatment Facility at Pani Khaiti in Assam. To treat the biomedical wastes of nursing homes, hospitals and laboratories of the city, they have to sign an agreement to treat the waste in the common biological treatment facility. Of course, there is the proposal to establish two more CBWTF in the state - one in Galeki and the other in Barak Valley. According to Swachh Bharat guidelines, the state government hospitals will now have to prepare a waste magement plan for disposal of bio medical waste as per the Swachh Bharat Guidelines for public health facilities. The new measures from the Union Ministry of Health and Family Welfare, mandate the state run hospitals and health care institutions to collect, store and dispose waste in accordance with Bio Medical Waste rules and any other amendments and notification of the state PCB. It says all infected, radioactive, cytotoxic health care wastes will be segregated, collected, stored, transported and disposed as per the set guidelines of safety, ensuring that at no stage it gets mixed with general waste. While health institutions across the country have benefitted from various measures adopted in their facilities for magement of bio medical waste, there has been a lack of similar initiative in Assam.

Holding of workshops for district officials cannot guarantee the practice in reality. At the interest of public health, basic public health care determiners like safe drinking water, environmental sanitation and nutrition should have to be given priority. Chief Minister Gogoi said that the Assam government had accorded priority to pure drinking water and sanitation to keep diseases at bay. Drinking arsenic-contamited water over a long period of time causes skin, lung, liver, kidney and bladder cancer. In CM's own constituency, providing arsenic free water is becoming a political football. In the beginning of the current year, NHRC issued show cause notice to the Chief Secretaries of 27 states including Assam and neighboring NE states calling for a detailed report on the steps taken to address the problem of flourosis in drinking water. 18 districts of Assam have become prone to arsenic and fluoride contamition. Mass poisoning at the hands of the Government in the me of providing public health services is well evident in Tapatjuri. Flouride contamition of drinking water supplied by the PHE Department through hand pumps has crippled around 4,000 people in Tapatjuri, Dikharumukh and Nijparkhowa villages of Haladhiati area under Akashi Ganga Gaon Panchayat in gaon district.

Despite Government's apathy towards these people, flourosis in a number of children is being cured by a group of social activists with the use of safe drinking water and low cost micronutrients. This happens due to the intervention of a group of social workers led by Dharani Saikia, with the active support of former PHED Chief Engineer AB Paul, Gujrat-based NGO INREM Foundation and Bangalore-based Arghyam. Health and development are intimately connected. While insufficient development leads to poverty, ippropriate development results in prevalence of environmental health problem. Ex Health Minister Dr Sarma himself says that health does not mean just doctors and hospitals but everything that influences the well being of a human being. Despite this realization, he failed to initiate an integrated approach .The current Health Minister has failed to even showcase this goodwill.

(The writer is an Assistant Professor, Economics, DCB Girls' College, Jorhat)