How sick is Meghalaya’s Health System?

The health sector in Meghalaya is notorious for poor medical services coupled with shortages of manpower and resources. Health centers in the rural areas are running without proper medical facilities/supervision. Medical equipments and diagnostic machines are either not working or left to waste without ever being utilized in the absence of specialists and experts manning them. Institutional failure in the rural areas of Meghalaya has become endemic. It took the Estimates Committee of the Meghalaya Legislative Assembly 11 years to discover that valuable equipments and machines meant for the trauma and accident centre were lying idle at the Nongpoh Civil Hospital. The trauma centre is all but non existing since the centre is being used by the District Medical & Health Office, Ri Bhoi since 2010. The Committee also found that X-ray machines and ventilators have been dumped in a room. These and many other cases speaks volume on the non functionality of the health care delivery system which caused inconvenience and unnecessary burden for many patients who are force to seek medical assistance elsewhere. Sadly this is a regular occurrence in many parts of the state. Only recently a scam worth crores was unearthed regarding purchase of expired drugs and an enquiry on the same have gone nowhere.

This is not to imply that things are any better in towns and cities. There is no uniformity in the functioning and operations of different health care centers such as the hospitals even in Shillong with each hospitals following different rules, norms, requirements, fees etc. This has created anomaly in health care delivery with the worst sufferers being the poorer and weaker section of the society. Meghalaya Health Insurance Scheme (MHIS) was introduced with the objective of providing health insurance to all residents of the state excluding state and central government employees. The initial enthusiasm however has dampened with complaints emerging from those using the health smart cards especially in the first phase (2012). The insurance scheme was supposed to provide a safety net with the objective of enhancing the health sector of the state. But not many are happy with the way it is operated. Moreover private hospitals follow different criteria for billing, reimbursements etc. Taking advantage of the Insurance scheme private hospitals purportedly inflate bills, operation charges etc which ultimately have to be borne by the patient who do not know the different slabs for different treatments. In fact some beneficiaries using the health smart cards have received bills which are much higher compare to those not using the smart card for the same medical service/procedures. Instead of getting free medical services they end up burning their pockets. Interestingly there were only two hospitals in the first phase (2012) of the MHIS. In the second phase (2015) almost all private hospitals have empanelled with the scheme with the amount of coverage increasing from 1.60 to 2 lakhs.

The anomaly in the health care delivery system in Meghalaya has caused many to ask if there are any regulations, norms and ethics on medical care and practices. And if there are, how many of our health centers actually complies with those? Are there any penalties for violations etc? The Medical Council of India (MCI) has stipulated the Code of Ethics Regulations, 2002 which defines duties and responsibilities of Physicians, Doctors, Surgeons etc while providing medical care. However these duties are meaningless if rights are not respected which provides opportunity to violate and flout all medical norms. Glaring medical negligence and callous attitude of health care givers have been reported from time to time.

A few weeks ago a mentally ill patient accompanied by the police at night was refused admission at the Medical Institute of Mental Health and Neurological Science (MIMHANS) at Lawmali, Shillong simply because there were no doctors. It is alleged that this is not the first time that MIMHANS has refused admission to those approaching the Institute seeking medical assistance. Most of the time the police have to take up custody for such patients who are picked from streets, market places etc because of the callousness from those running the institute. No matter what explanation the Institute may offer, the issue of institutional failure in the health sector cannot be whisked away. At the core of this failure is the complete absence of health rights and the indifference towards respecting such rights by health authorities/institution as was the case of the mentally ill patient. She has as much right as any other patient for admission in the Institute, no matter what time of the day. The denial for her admission is a denial of her right to proper and timely health care.

Cases of health violations continued unabated because there is complete absence of accountability. This has further exacerbate the situation on rights violation especially against the disadvantaged group who would rather don the christian spirit and show magnanimity to forgive and forget. Those who wish to file a complaint are coerced or persuaded to keep their mouth shut. It is about time we highlight violation of health rights by bringing them to the public domain. The right to proper health and medical services has to be deliberated and debated for a comprehensive and holistic health policy to emerged. On this front it is interesting to note that the National Human Rights Commission in collaboration with Jan Swasthya Abhiyan (JSA) an NGO on public health rights have been conducting public hearing on violation of health rights in different regions of the country. The proceedings from these series of public hearing is expected to have an impact on the National health policy which is under consideration by the Government of India. The public hearing for the North East zone is expected sometime in early 2016. Different committees have been formed in different states of the region for compiling cases from aggrieved person/s for the hearing. The Campaign for People’s Right to Health in Meghalaya is one such committee for facilitating cases on health violations from Meghalaya for the public hearing. This is an opportunity for the people of Meghalaya to participate with their grievances which will have a direct bearing on the health sector/authorities within the state.

There has to be a systematic overhaul of public health delivery system in Meghalaya with health rights at the core of such a structural change. Accountability and transparency is an important structural change that requires immediate attention if the health sector is to improved. It is goes without saying that health rights and governance in the health sector are mutually reinforcing. The fact that the National Human Rights Commission has shown interest in these public hearings is a testimony that health rights is as important as other rights if not more. This assume all the more importance given that there is increasing commercialization/privatization of the health sector in India. The health sector as such needs to be regulated so that right to health remains a public oriented policy and not left at the discretion of private health providers.

 

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Phrangsngi Pyrtuh Written by:

Phrangsngi Pyrtuh teaches in a college and is a fellow traveller

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