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Panacea for the Development of North Eastern Region
The Vision Document acknowledges the many distinct challenges that the region faces including troubled history and geo-politics, environmental vulnerability and rough terrain, seclusion and insurgencies, poor infrastructure and weak governance, and limited connectivity. Floods and natural disasters recur periodically and adversely affect the lives of millions in the region. Equally disturbing are the recurring conflicts, as in Assam recently, that tend to destabilize society. It is this confluence of factors that makes the deprivations experienced by people living in the North East different from those of communities residing in other parts of the country.
Five additional factors in particular have adversely affected progress of the North Eastern Region over the years.
Weak governance: Several deficiencies in public administration have constrained the development of the region. There is a shortage of trained and professional manpower in the region at all levels of governance. Lack of sufficient transparency and poor implementation and monitoring have resulted in sub-optimal utilisation of public resources. The supra-institutions, namely Ministry of Development of North Eastern Region (DoNER) and North Eastern Council (NEC), have also not been sufficiently equipped to serve the region. Despite considerable financial allocations, norms of many schemes of the Central Government have not been appropriately customized to address the unique problems of the North Eastern Region.
Disturbed conditions: Peace is a pre-requisite for progress. Many States in the region have been affected by prolonged internal disturbances and conflicts. The consequent insecurities have adversely affected development.
Poor infrastructure: Both the physical and social infrastructure in the region remains insufficient to make up for the region’s disadvantage on account of its geography and particularly the mountainous terrain. Road, rail, air and telecom connectivity is poor. Shortage of power supply is a major constraint.
Limited trading opportunities: The region has a long international boundary (about 96 percent) with China and Bhutan in the North, Myanmar in the East, Nepal in the West and Bangladesh in the South and West. Enhanced cross-border trade has vast economic potential of promoting growth and employment in the Region.
Limited capacity for resource mobilization: The capacity of North Eastern States to mobilize their own resources is limited. Hence they are heavily dependent on Central transfers for development projects. All States in the region fall under the Special Category, i.e. States where Development Plans are centrally financed on the basis of 90 per cent Grant and 10 per cent is to be mobilized by the States. In addition, Special Category States are allowed to use up to 20 per cent of the Central Assistance for non-plan expenditure. Though at present 10% of the annual budget of non-exempted Ministries is earmarked for the North Eastern Region, yet there is no separate Plan in the Ministries for the region which will ensure close monitoring and review of effective utilization of the resources earmarked for the region at the subject Ministry level, Ministry of DoNER level or at the NEC level. Unutilized funds in the Ministries are routinely diverted to the Non-lapsable pool of resources.
| Despite considerable financial allocations, norms of many schemes of the Central Government have not been appropriately customized to address the unique problems of the northeastern region |
Levels of human development vary enormously across the States in the region. Some States fare much better on human development indicators than the national averages, and others much worse. Per capita incomes in 2010-11, for instance, varied from Rs 29,684 in Manipur to Rs 81,159 in Sikkim. Sikkim recorded the highest growth rates in income among all Indian States over the period 2005-06 and 2011-12. The infant mortality rate (IMR) in Manipur (14 per 1,000 live births) is similar to that of Kerala. On the other hand, Assam reports an IMR of 58. Only 25 per cent of children are fully immunized in Arunachal Pradesh as against 74 per cent in Mizoram and 85 per cent in Sikkim. The literacy rate in Mizoram is 92 per cent and 67 per cent in Arunachal Pradesh. Sikkim also reports the lowest proportion of underweight children in the country.
The North East of India remains unmatched for the richness of its natural resources and its ethnic and cultural diversity though it continues to be regarded as one of the ‘most backward regions’ of the country. The region has been identified as one of the world’s biodiversity hotspots as it hosts species-rich rain forests, supports a diverse flora and fauna and is the centre of origin of several crop species. Forest and water resources, minerals, petroleum and gas are also available in abundance.
Breathtaking flora and fauna, heritage drawn from the ages and the presence of a large number of diverse groups makes this place a treasure grove. If culture represents the entire gamut of relationships which human beings share with themselves as well as with nature, the built environment, folk life and artistic activity, the North East is a ‘cultural and biodiversity hotspot’, whose immense potential is beginning to be recognised.
To sum, up, the North Eastern Region faces special challenges and at the same time, offers extraordinary potential for human development that can advance peace and prosperity. As noted in the Approach Paper to the 12th Five Year Plan.
The North Eastern Region has special challenges, which need new and innovative solutions. It has enormous development potential, but its growth has been slow. Development of infrastructure, better connectivity, greatly improved access to trade with the rest of the country and ‘Look East’ window to Bangladesh and South East Asia will yield rich results. The low levels of private investments in the region are due to the perception of limited opportunity and difficult logistics and access. These are complex and sensitive issues for which imaginative solutions must be found during the Twelfth Plan.
There is a need to rapidly improve human development, promote equity, and at the same time, expand economic opportunities, especially among the youth.
There is need for Government of India and the NEC to engage more intensively with the States in the progress of development of the region as a whole.
It is against this background that the NEC took up issues pertaining to the region; in doing so, seven priority areas were identified.
| The northeastern region has special challenges, which need new and innovative solutions. It has enormous development potential, but its growth has been slow. |
The current recommendation focuses on:
Enhancing human capabilities: (particularly health) The recommendations that follow focus on a specific area of importance - health.
Recommendation
A distinct Plan for the north east to enhance outreach and delivery of services with additional manpower both in terms of medical professionals as well as other service providers; emphasis on use of technology and innovative methods to provide health care.
Special provisions under the National Rural Health Mission (NRHM) have yielded many positive health outcomes across the region. Contributing to these achievements have been:
- The separate Division setup in the Ministry of Health and Family Welfare (MoHFW) to address the health needs of people of the North Eastern Region (NER)
- The Scheme for Forward Linkages to NRHM provides crucial funding to the North Eastern States for the creation and up-gradation of secondary and tertiary health care facilities.
- Yet health coverage remains far from satisfactory as evidenced from the wide inequities and deficiencies in access to good quality health care. The recommendations for the health sector fall primarily in three categories
- Preparation of a separate Plan for the NER within the Ministry,
- Strengthening outreach
- Enhanced manpower.
(a) A distinct Health Plan for the North Eastern Region: It is recommended that the Ministry of Health and Family Welfare after time bound consultations with all the North East States, NEC and Ministry of DoNER prepare a separate plan for the region. The implementation of the plan needs to be closely monitored by the NEC as well as the Ministry of DoNER. It is further suggested that a review mechanism be put in place at the NEC Secretariat, which will monitor the progress on a quarterly basis.
More specific recommendations are listed below:
(b) Strengthening outreach
Primary Health Care: Priority should be given to strengthening the quality and reach of primary health care services. The following suggestions emerged from the discussions:
Community participation and citizen engagement: by ensuring among other things,
- An enhanced role for elected representatives as well as institutions of local governance; strengthening the role of civil society and non-governmental organisations;
- Strengthening existing Village Health Committees (or Health, Sanitation and Nutrition Committees);
- Improving the quality of training and supportive supervision, and
- Instituting a formal grievance redressal mechanism at the block level.
Sub-centre and PHC norms: Permit flexible norms to ensure coverage of population based on both time taken to reach the facility and distance.
Special needs: Additional measures are needed to address the specific health needs of different states such as malaria, HIV/AIDS, de-addiction and mental health programmes.
Reach of health services: Given the physical and geographic specificities of the region, the following options should be examined:
Telemedicine: Telemedicine centres as originally planned by the Indian Space Research Organisation (ISRO) for the region should be made fully functional within a specified period and capacity building of staff ensured. North East Space Applications Centre (NESAC) should undertake an awareness campaign across the region to induce states to make use of this facility. MoHFW should also plan for a telemedicine grid for the region in consultation with ISRO/NESAC and ensure linking up with premier health institutes outside the region as well.
Mobile Medical Units: North Eastern States should be encouraged to come up with innovative mechanisms to provide mobile medical services with basic diagnostic equipment to the remote parts of the region. The network of Mobile Medical Units (MMUs) should be expanded to cover to improve access of health care among under-served populations. For example, boat clinics of C-NES in Assam are providing curative and emergency care for the population residing in islands and flood plains of the State. It is recommended that under NRHM, the States of the North East should be encouraged to come up with innovative mechanisms to provide mobile medical services with basic diagnostic equipment to the remote parts of the region.
Ambulances: The reach of 108 ambulance services should be extended to cover the entire population of the region. To achieve this coverage, it might be necessary for the Government of India under the NRHM to continue sharing 50 per cent of the operational expenditures beyond the third year.
Under the present arrangement, NRHM covers 60 per cent of costs in the first year, 40 per cent in the second year and 20 per cent in the third year. Thereafter, the full costs have to be borne by the State Governments.
District hospitals: All district hospitals and First Referral Units (FRUs) should be fully equipped with facilities and necessary staff. They should obtain NABH/ISO accreditation.
Appropriate infrastructure: to optimize utilization of resources under schemes like NRHM, environmentally appropriate and cost-effective structures for health facilities such as pre-fabricated structures should be encouraged.
AYUSH: AYUSH should be promoted across the region by pro-actively seeking the participation of NGOs and if needed, by setting up a Directorate of AYUSH in the States.
Human resources: Following are some recommendations to enhance availability of medical and paramedical personnel:
| It is recommended that under NRHM, the States of the North East should be encouraged to come up with innovative mechanisms to provide mobile medical services |
Training of doctors and nurses: The Central Government should consider 100 per cent funding support for setting up of medical colleges by the states. Every State should have at least one medical college and one nursing college/training institution for Auxiliary Nurse Midwife/General Nursing and Midwifery (ANM/GNM). In addition, states should introduce a training course for ANMs that gives them the eligibility to become GNMs.
Admissions to Medical Courses: The Government should consider allocating an additional 5 per cent of admissions in the Medical Colleges to candidates from the region in order to address the problem of seats falling vacant after admission on account of migration by selected candidates to States outside the region. Alternatively, the Government could consider increasing reservations in medical colleges outside the region for students of the northeastern region.
Faculty of Medical Colleges: Special permission should be granted to faculty of adjacent medical colleges that are situated within a reasonable distance to teach in more than one college. In addition, virtual classrooms should be allowed at the undergraduate level in medical colleges so as to benefit from specialist faculty who may not otherwise be physically present. Both these measures are likely to address the shortage of trained faculty in the region.
Incentivizing medical professionals: both central and state governments should extend appropriate financial and non-financial incentives to medical professionals to serve in the region.
