Health Infrastructure & Services
In the North-East, a widespread rural health infrastructure already exists but it needs to be improved both quantitatively as well as qualitatively. On the one hand the number of PHCs and CHCs are much below the required norm and on the other hand, many of them are not fully functional.
PHCs in the remote hill areas are grossly understaffed, many are run only an Auxiliary Nurse-Midwife (ANM) or a Pharmacist. It is a callous waste of resources that only a small fraction of the existing infra-structure is being used. Due to disuse and neglect, the buildings are in a state of dilapidation and decay. Equipments are also not fit for use due to lack of maintenance.
In the absence of doctors, the skeleton paramedical staff provides the services, which obviously, are substandard. This situation has given rise to rampant quackery and corruption.
The geographical structure of the region is difficult for easy movement. In plane areas, there are large number of swamps and the terrain is criss-crossed by numerous rivers, making it flood-prone. This makes movement very difficult, especially during the rainy season. In the hills, one encounters steep ridges and deep valleys connected by narrow and slippery paths, through heavily forested areas, frequently interrupted by gushing streams and landslides. The radial distance covered by a PHC is higher than the national average everywhere. Under such circumstances, transportation of serious patients to the nearest dispensary is problem, making chances of survival very dim.
In Arunachal, patients are sometimes airlifted by helicopters from remote areas to Itanagar, but this helps only a minute percentage of the population and the costs are prohibitive, hence unviable.
Even in PHCs which function, facilities are not adequate and available facilities are not fully utilized. There seem to be several underlying reasons for this malady. Firstly, the PHCs are overcrowded and have to cater to a much larger population than they are supposed to attend.
As a consequence, doctors are not able to give sufficient attention and time to the patients. Secondly, proper storage facilities are not available and supply of medicines is irregular and insufficient. But it is the frustration and demoralization among doctors from lack of opportunities for promotion and harassment by petty bureaucrats which debase the medical services. The situation is further compounded by a growing trend wherein a large number of patients who can be treated at the PHCs are referred by doctors to their own private clinics. As a consequence, health care is becoming very expensive which consumes around 40 - 50 per cent income of a typical rural household. Despite high costs, quality of the medical service remains very poor, compelling many people to go for treatment elsewhere, despite the existence of four medical colleges and a number of specialist hospitals and expensive private nursing homes as well as Ayurvedic and Homeopathic colleges in the region.
The CHCs are as good as they are non-existent. Very often only the buildings exist. Some non-medical or para-medical staff man the show. The CHCs are supposed to staff resident specialists. They are generally not available as they are "attached" to some hospital or dispensary in the city or commute between the CHC and the nearby town where they have private practice.
Perhaps, the brunt of this unwholesome condition is borne by women. As such their accessibility to health services is limited due to factors like lack of female health care providers, large distances involved and, in many cases, their powerlessness in deciding to visit a doctor. But, it is the special needs of women pertaining to their role as birth givers which make them especially vulnerable. Rural women have to work hard even during advance stages of pregnancy and antenatal care is virtually missing in remote areas. Even in Assam, which is much advanced, 80 per cent of deliveries in the rural areas are still conducted by Traditional Birth Attendants. This is reflected in the sex ratio which is highly adverse in the entire North-East. In Arunachal it is the least with 859 females against 1000 males. Only in Manipur it is 927, but still far below what is required.
Utilization of family planning services is widely varied as is indicated by the Couple Protection Rate which is far below the national average of 43.5 (1994) except in Mizoram where it is 45.9.
In fact, family planning is unheard of in remote interior parts where on the average 8-10 children are born to a woman of which 2-3 survive. Girls get married at an early age and birth spacing is not practiced. The situation is specially disturbing in Arunachal where poor women are treated as commodities since ‘bride price’ is paid. Exhaustion and despair is seen writ large on the faces of emaciated and anaemic women for having given too many and too close births.

Disease Profile
Generally speaking, North-East regional profile is like a micro version of the all-India profile. Water, sanitation and environment related problems continue to cause more than 80 per cent of the ailments. Anaemia among women and malnutrition among children are widely prevalent and so are skin diseases and helminthic infestations.
However, there are certain differences. While diseases like guinea worm infestation are conspicuous by their absence, diseases like malaria, Japanese encephalitis, hepatitis and typhoid are endemic in some parts of the region. The entire North-East is prone to Iodine Deficiency Disorders. At least in two states, namely Tripura and Meghalaya, availability of Iodized salt is just half of what is required.
In some parts zoonotic diseases and parasitic infestations are direct consequence of man-animal proximity. Sharing the same roof with domestic animals is widely prevalent among all hill and some planes tribes as well as certain immigrant communities. In some parts of Nagaland, it was heard, that if a domestic animal is found to have TB, the entire household will have the disease and vice versa. The nexus among man-animal proximity, unsanitary conditions and lack of personal hygiene manifests itself in frequent outbursts of diarrhoea which sometime reach epidemic proportions. Lack of safe drinking water further aggravates the problem. Immigrant tea garden labourers suffer a heavy toll of life every year from water and sanitation related problems.

AIDS TIME-BOMB
HIV/AIDS is already a serious problem in Manipur. Its tentacles are spreading to other states. The situation is sending alarm signals in Nagaland. The problem is slowly rising in Assam but mass awareness is still to come. The nexus of drug abuse (injectible) and irresponsible sex is at its worst. In Manipur there is a peculiar situation of injectible drug abuse overtaking the sexual route of transmission. Testing facilities are inadequate and limited to Elisa tests. Confirmatory tests are done at Calcutta. Also there are very few licensed blood banks in the region.
The problems described above are capable enough to create a highly undesirable health scenario but for the overall better literacy rate, especially among women, which is better than the all India average in all the North-Eastern States, barring Arunachal and Meghalaya, the combined negative impact of the above factors is not only kept in check but also offset to a large extent.
One very special feature of the region is that the climate here is highly supportive of life - all kinds of life. The entire region is very rich in edible tubers, leafy vegetables, mandarins and other citrus fruits, ferns and a variety of edible wild mushrooms. A lot of it grows in the wild. Hence, deaths due to starvation are not very common. And yet, there are a lot of undesirables conditions. The major problem comes from lack of health awareness. The problem in itself is not difficult to tackle, but its enormity makes it so. Concerted and well coordinated efforts on the part of NGOs and their close collaboration with the government are needed to make positive strides towards health for all.

Developement Sectors
The economic development in the North-East is very slow. There are strong historical, geographical and political reasons for this situation. Until Independence, North-East was a closed book for the rest of the country and deliberately kept so by the colonial powers. The British had developed some infrastructure basically for transportation of coal, tea, jute and crude oil. This minimum transport and communication network suffered a severe jolt as important road and rail network connecting the North-East with the rest of country went to East Pakistan after the partition of India. Hence the first priority before the Government of India was to develop the necessary infrastructure which has been continuing through all the Five Year Plans especially from the fourth Plan onwards. In practice it has been a mere tokenism, thanks to the so called North-East experts. Firstly, allocations have not been sufficient, more than that, the process of planning itself seems to have been haphazard and shows lack of knowledge and understanding of the area and the vision in deciding about the priorities within the priority infrastructure sector.
The region is rich in natural resources, not much of it has been tapped or ploughed back for its development. Added to this, there has been an unhindered, incessant mass migration from across the border which has already unsettled the demographic balance in Tripura and is a cause of major concern today in Assam and everywhere else in the North-East. Conglomeration of these negative factors have exerted such a retarding force on the developmental process that people are losing hope. The present insurgency in the region is the manifestation of their frustration. This has made the situation even more complex by spoiling the investment climate and precipitating flight of capital from the region.

Major Priority Areas
The economy of the North-East is predominantly agricultural. Owing to rudimentary techniques still prevalent, productivity is low which is further decelerated by declining land holdings. Increasing productivity in this sector depends upon simultaneous development of a host of other factors or ‘basic infrastructure’ like irrigation, power, transport and communication, storage facility, credit facility, marketing network as well as technological know how. These factors act upon the process of development individually as well as collectively. A cursory examination of these factors reveals that:-

• Though agriculture dominates all other sectors, with 77 per cent people engaged in it, Green Revolution has not arrived in the North-East except in a limited way in Manipur.

Irrigation in the northeast has received very low priority. The reason for this neglect is an erroneous belief that the development of irrigation infrastructure in the North-East is unnecessary since the region receives a lot of rainfall. Here, the facts that the rainfall is uneven over space and time, that there is 1.57 million hectares of drought prone area in Assam, that negative rainfalls are frequent etc. are totally overlooked.
The problem of floods which destroys standing crops and takes a heavy toll of life and property every year has been allowed to continue year after year.
Shifting cultivation in the hill states in which nearly 35 per cent of tribal households are engaged is another reason for the low agricultural yield. It needs delicate socio-cultural sensitivity and considerations as well as appropriate technology inputs. The combined effect is that the North-East lags behind rest of the country by 30 per cent in meeting its food grain requirements.

• Per capita power consumption in the North-East is one of the lowest in the country. The region has 36 per cent of the country’s total hydel potential of which less than 5 per cent is being utilized at present.
• Grossly inadequate transport and communication network create the biggest bottleneck. It also enhances the feeling of isolation among the people. Manipur, Mizoram and Meghalaya are still out of the railway network which has negligible coverage in Nagaland, Arunachal and Tripura as well as insufficient coverage in Assam.
• Tea is the major plantation crop. There are 769 tea gardens in Assam which account for more than 50 per cent of the country’s tea production. But, deliberate government policies has denied Assam its rightful share of benefits accruing from the tea industry. There are also good prospects for rubber and coffee in Assam and Tripura.
• Full potential in the allied sectors like horticulture is yet to be realized. North-East region is one of the three major centres of diversity for citrus in the country with 17 species and 52 varieties. It is stagnated due to lack of technological know how.
• The North-East has abundance of minerals and other natural resources like oil, gas, coal, and widespread forests. The oil-fields in Assam produce more than 50 per cent of the total crude in the country (around 5-6 million tons annually). Yet, there are no major petrochemical based industries in the region.
• Development of industries is closely linked with the development of the primary sector since the same infrastructure like power, transport and communication, marketing facilities etc. are needed. It is obvious then that this sector has also not developed. The typical scenario is that there are mainly small size, low capital and labour intensive units which operate much below the average productivity level of the country.

Development process in the region seems to have been mired in wasteful sophistry and circuitous arguments like "since there is no infrastructure, large industries cannot be set up in the North-East" and in the same breath "since there are no large industries, infrastructure development is not necessary".
It is heartening to note that in spite of the above constraints, there have been positive developments like significant sectoral shift from agriculture to trade and services indicating absorption of surplus manpower from the agriculture sector in the urban economy, high female literacy and high female labour force participation and steady progress in animal husbandry especially in Mizoram, Nagaland and Meghalaya. These spontaneous people’s actions are being supplemented by a new awakening in the government. There are now some important public sector projects in the pipeline and a special economic package for the North-East. What the North-East needs today is honest, sincere and timely implementation of the projects and a more pragmatic and just planning which are region/need-specific. In this process, the governments as well as national agencies like the Voluntary Health Association can play significant roles.

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