Bine: The healthcare system in Arunachal Pradesh is facing serious challenges, as highlighted by the recent Health Dynamics of India report published by the Ministry of Health and Family Welfare.
The report reveals an alarming 80% shortfall of specialist doctors at Community Health Centres (CHCs) across India. In Arunachal Pradesh, this issue is particularly severe, with only eight of the required 224 specialist positions sanctioned and filled, leaving a staggering shortfall of 216 specialists. This shortage severely hampers the state’s ability to provide essential medical care to its residents.
In the Upper Siang district, all four CHCs lack specialist doctors. District Medical Officer (DMO) Dr Gepeng Litin acknowledged the challenges, stating, “CHCs are supposed to have at least four major specialist doctors, but due to shortages, we cannot provide specialists in many centres, including district hospitals.” This deficit extends to healthcare buildings and manpower, which fail to meet the prescribed norms.
However, a lack of specialist doctors is not the only issue in rural and remote areas like Mariyang in the Upper Siang district. While CHCs are designated to have specific facilities, most residents rely on distant hospitals due to inadequate infrastructure at these centres. For instance, residents of Mariyang travel approximately 79 kilometres to Pasighat’s Bakin Pertin General Hospital for even minor medical needs.
A resident shared, “We don’t go to the CHCs for treatment because there are no proper facilities. For emergencies or even minor injuries, we are referred to Pasighat. Without basic amenities like X-ray machines or operation rooms, the CHCs fail to meet healthcare needs.”
The CHC in Mariyang has 15-bed facilities in male and female wards but lacks an operation theatre and X-ray room. This is despite rural CHCs being designated to have 30-bed facilities, one operation theatre, and an X-ray room. While it does have a labour room and laboratory, locals also report irregular attendance by medical staff. Many residents resort to buying medicines from pharmacies without consulting doctors due to the unavailability of medical professionals.
Addressing this, Dr Litin stated, “Currently, Mariyang has two doctors—one allopathic and one AYUSH doctor. We have also recently appointed a dental doctor, bringing the total to three. We are actively requesting more doctors. While the overall health infrastructure needs improvement, there has been progress. We are receiving support from the Health Commissioner and Secretary. The performance of health services is improving. A general review was recently conducted across multiple districts, with a follow-up meeting held in November to assess further improvements. Additional staff would help, but the current system is as good as it can be. In emergencies, we have an ambulance service to transport patients to district hospitals if needed. Even with road blockages, our system manages emergencies effectively.”
While CHC labour rooms are operational and staff are well-trained, the situation in remote villages like Bine village in Adi Pasi paints an even grimmer picture. The sub-centres, the first point of contact between the primary healthcare system and the rural community, are severely under-resourced.
The Bine sub-centre, located a few kilometres from the Mariyang CHC, is intended to be a lifeline for medical emergencies but faces acute staff shortages, medical equipment, and basic medicines.
The facility is in disrepair, with visible signs of neglect, such as water leakage and structural damage. A local health worker explained, “We don’t have proper instruments for basic procedures like stitching wounds. For instance, if a patient comes in with a hand injury requiring stitches, we often can’t perform the procedure due to a lack of proper tools.” Poor road connectivity exacerbates these challenges, with villagers recounting instances of carrying injured relatives for hours to the sub-centre, only to find it unequipped to provide help.
Local authorities claim they provide necessary services, but residents dispute these claims. “The authorities show everything as being in order, but they never check the actual conditions on the ground,” one villager said. Despite a building renovation in 2021, there has been no real improvement in healthcare services.
Nano Moyong, the Zilla Parishad Member (ZPM) from Mopom Circle, echoed these concerns. Dr Gepeng Litin added that a new building for the wellness centre is under construction to replace the current dilapidated structure. Proposals for new medical equipment and supplies have also been submitted. However, the district continues to face a severe shortage of functional staff.
Another medical staff member in Bine noted that the lack of adequate staff quarters poses significant challenges. Issues such as water leakage and drainage problems make it difficult for medical personnel to reside in these facilities, further impacting healthcare service consistency. Although the district has an ambulance service to transport patients during emergencies, road blockages often delay this service, jeopardising patient outcomes.
“Our elders and children suffer the most,” said a resident in Bine. “We don’t need extravagant facilities, just the basics—staff, medicines, and proper equipment. Even that feels like a distant dream.”
The ZPM of Mopom Mariyang Circle emphasised the need for a fully functional facility in Bine, equipped with proper accommodations for medical staff. Without this, consistent healthcare services remain unattainable. Dr Litin cited ongoing support from the Health Commissioner and Secretary, alongside reviews to assess and improve health services. However, significant gaps in infrastructure, staffing, and resources still exist.
It is worth mentioning that until these issues are resolved, residents of Upper Siang and similar districts will continue to struggle for access to even basic healthcare services. Moreover, the healthcare crisis in Arunachal Pradesh, particularly in rural districts like Upper Siang, highlights the deep disparities in healthcare access across India.
The shortage of medical specialists, lack of infrastructure, and poor road connectivity are major barriers preventing rural residents from receiving timely and effective medical care. The situation at the Bine sub-centre exemplifies the broader challenges, where outdated infrastructure, insufficient staffing, and a lack of basic medical supplies contribute to the villagers’ plight.
Attempts to contact the Health Minister regarding the overall rural health infrastructure scenario of Arunachal Pradesh went unanswered.
This story has been published as part of the AIPP-EastMojo Fellowship 2024
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