Primary Health Centres in the state were found to be functioning with inadequate manpower. (Morung file Photo)
Nagaland’s healthcare manpower crisis runs deep
• 100% GDMO shortage in some district hospitals
• Specialist doctors missing in up to 95% of CHSs
• 86% ANM shortage at PHCs
Morung Express News
Dimapur | April 19
The Comptroller and Auditor General (CAG) of India audit report has revealed severe shortages of specialist doctors, nurses and paramedical staff across District Hospitals (DHs), Community Health Centres (CHCs) and Primary Health Centres (PHCs) in Nagaland, covering the period 2017-18 to 2022-23. The Subject Specific Compliance Audit (SSCA) on “Public Health Infrastructure and Management of Primary Health Services,” tabled as part of the CAG Report for the year ending March 2023, revealed substantial discrepancy in healthcare manpower across the state’s primary health infrastructure.
District Hospitals
According to the report, in case of DHs, major shortages existed in the cadre of specialist doctors from 8 to 56 per cent, General Duty Medical Officers (GDMO) from 43 to 100 per cent, Staff Nurses from 4 to 60 per cent and paramedical staff from 13 to 88 per cent.
The audit, however, noted excess manpower in specialist doctors in two DHs, ranging between 33 and 61 per cent, pointing to uneven distribution of medical personnel. Further, there was disparity in availability of adequate number of specialist doctors in the DHs as per Indian Public Health Standards (IPHS) norms.
Shortages of General Medicine doctors were recorded in six DHs including Kiphire, Peren, Longleng, Phek, Zunheboto and Mokokchung, while DHs in Kohima and Dimapur had excess. Further, there was shortage of Paediatricians in six DHs, Peren, Mon, Phek, Tuensang, Zunheboto and Mokokchung and excess of Paediatricians in DH Kohima. Similar disparity was noticed in remaining nine mandatory Departments - ENT, Orthopaedics, General Surgery, Ophthalmology, Dental, Obstetrics & Gynaecology, Anaesthesia, Radiology and Pathology.
“This implied that the State Government has not adopted a policy of systematic distribution of doctors among the available DHs,” the report stated.
As regards availability of specialist doctors, only three departments had specialist doctors available (10 out of 11 DHs) as per the norms. Of the 11 DHs in the state, only DH Kohima had adequate specialist doctors across all mandatory departments. It also observed that in all the DHs, adequate number of specialist doctors were available in General Medicine except in DH, Longleng.
Community Health Centres
The situation in Community Health Centres (CHCs) was found to be equally alarming, with specialist doctor shortages ranging from 67 to 95 per cent. Out of 23 CHCs in the State, the specialist service in Obstetrics & Gynaecology was available only in five CHCs - Noklak, Pungro, Jalukie, Meluri and Tobu.
Shortages in GDMOs, Nurses and Paramedics stood at 29 per cent, 62 per cent and 12 per cent respectively. Audit also observed an excess of manpower at CHCs in Obstetrics & Gynaecology (0125), MBBS-MO/SMO (1026), Staff nurse/ANM (0427), Lab Technician (1128) and Pharmacist (0529), which resulted in skewed posting of manpower at CHCs.
Primary Health Centres and Sub-Centres
Primary Health Centres (PHCs) in the state were found to be functioning with inadequate manpower. Shortfalls were recorded in GDMOs (11 per cent), Auxiliary Nurse Midwives or ANMs (86 per cent), Lab Technicians (64 per cent) and Pharmacists (33 per cent).
At the sub-centre level, 52 per cent of Health Sub-Centres (HSCs) in the state reported manpower shortages, ranging from 30 to 89 per cent across districts. Availability of HSCs in the District and the number of the HSCs which had shortages of manpower vis-à-vis the norms ranged from 30 to 89 per cent.
Peren district recorded the highest shortage, with 17 out of 19 HSCs facing shortage of manpower. The report also noted that no separate manpower has been sanctioned for Line Services and Support Services for paramedics and other staff in health facilities across the state.
The CAG has recommended that the state government ensure equitable distribution of doctors among health facilities. “The state government may ensure posting of specialist doctors and provide necessary emergency services as well as other specialist services in the deficient health facilities as per IPHS norms,” it stated.
