Achievements in Health Care Services
Information have today become an essential and inescapable part of all activities relating to the delivery of Health care services, be it for management of the day's work or for planning for a better tomorrow. Information are needed at all levels to enable us to think quantitatively, assess probabilities and take appropriate action.
The Statistical cell of the Department has been providing information to all categories of users through publication of service statistics, survey reports and studies. Here a brief of the achievements made by the Department in the delivery of health care services to the people during the VIIth Five Year Plan Period.
Although, only 15 Primary Health Centres and 6 Primary Health Sub-Centre were functioning in 1979, substantial increase in the establishment of PHSCs, PHCs have been made through the years. There are now 24 PHCs and 147 PHSCs functioning through out the State. With this, Sikkim has been the only State in the Country to achieve the National Norms of establishment of 1 PHC for 20,000 population and 1 PHSC for 3000 population. These Centres have Medical and Para-Medical Staff capable of rendering the basic Primary Health Care.
Construction of two, 100 bedded Community Health Centre at Singtam and Namchi have been completed and functioning. Another one hundred bedded Community Health Centre is under construction at Gyalsing. Proposal for construction of a hundred bedded Community Health Centre have been approved at Mangan and will be taken for construction during 1997-98.
Although greater stress have been given to Primary Health Care, curative aspect of health has not been neglected. The Central Refferal Hospital at Gangtok has been upgraded to 300 beds from 250 beds. To ease the congestion in the OPD Clinics, new emergency cum OPD comples has been added to the old building. For better diagnostic and treatment facilities, sophisticated equipments like Gastroscope, Ultrasound, Omniscope have been provided. Specialised services in the field of medicine, surgery anaesthesia, orthopaedics, paedritics, opthalmology, dental, dermatology and psychiatry have been added. Super-speciality in Cardiology with intensive coronary care unit has also been introduced. A State Level Blood Bank and Transfusion Unit with facilities for HIVF screening has also been set up.
Treatment for ailment for which facilities do not exist in the State are referred for treatment outside Sikkim and financial aid provided by the Government. This is a unique feature of the State.
Free medicines and free diet in all the hospitals and PHCs have been a great incentive for the rural people to avail of Health Services.
Construction of an apex 500 bedded Central Refferal Hospital at Tadong is on the verge of completion.
Construction of 21 units of staff quarters at Namchi Hospital has been taken up at a total cost of Rs. 64.00 lakhs.
A camp for providing artificial limb and other aid for the physically handicapped was organised at Gangtok. 336 patients received aids like wheel chair, crutches, artificial limbs, cosmetic gloves, etc.
Successful free Cataract Eye Camp and Intraocular lens implantation were organised at Singtam and Namchi in collaboration with the Fundation Eye Care, Himalaya, Netherland, Nepal.
Sophisticated equipment have been received free of cost under the German Community Grant for the use of STNM Hospital, Gangtok.
The F.W. & MCH programme was introduced in the state from 1976-77, since then it has been implemented as a people's ,programme through mass awareness activities. The performance under the programme has increased tremendously. Immunization for infancts against the six killer diseases, tuberculosis, diphtheria, tetanus, polio, whooping cough and measles have increased from below 30% to 85%. To improve the health status of mothers and children, MCH services are provided through all the hospitals and health centres. 15000 pregnant mothers, lactating mothers and other anaemic mothers are provided with prophylaxis against nutritional anaemic with the distribution of folifer tablets free of cost.
15000 Children below the age of five years are provided with similar facilities 20000 children are also provided with vitamin 'A' solutation annually to protect the children upto 6 years of age from night blindness. A post partum unit has been constructed and attached to STNM hospital, Gangtok for the care of mothers during antenatal & post natal period. To provide services to pregnant mothers at the rural areas, 293, indegenous Dias have been trained.
To bring the basic health services at the doorsteps of the rural mass, 345 Health Guides have been trained. However, we have 237 Health Guides functioning. These Health Guides are provided with health kits worth Rs.50.00 per month and also paid Rs. 50.00 as honorarium for the services rendered.
An ANM Training Centre has also been constructed and added to the STNM Hospital at Gangtok. The Centre has a capacity to admit and train 80 ANM Trainees annually. The Centre also provides training to senior ANMs for promotion to the post of Lady Health Visitors, as and when required.
Family Planning Services are provided free of cost to all the eligible couples through the Hospitals, PHCs and PHSCs. A team of doctors and paramedical staff have been trained for laproscopy operations. The team caters to all the four districts. The eligible couple protection rate has increased to 21.9% during 1993.
Tuberculosis has been the major health hazard in the State. To curb the further spread of the disease, Health Education is being imparted to the people regularly. One 60 bedded district Tuberculosis Centre in functioning at Namchi with 10 bedded mini DTC in the other 3 Districts. The stress has been on domicilliary treatment of the disease. Tuberculosis Control Programme has been given top priority and District Tuberculosis Control Societies are being formed in the four Districts for implementation of Directly observed Treatment Short course (DOTs) which will be funded by the World Bank. Programme to scrutinise opinion leaders are being organised at the District and PHC Levels to create awareness amongst the people regarding various aspects of Tuberculosis Control.
Although Leprosy is not a big Health problem, a 20 bedded temporary Hospitalisation Ward has been constructed at Sajong, at a cost of Rs. 21.00 lakhs.
Sikkim has been declared as a goitre endemic state on the basis of the sample survey conducted by ICMR in 1976. The prevalence of goitre in the state has been estimated to be around 56%. To control the prevalence of goitre, sale of non iodised salt has been banned throughout the State under the Prevention of Food Adulteration Act, 1954 w.e.f. 11th Sept. 1985. A State laboratory for estimation of iodine in the iodise salt on sample basis has been set up at Gangtok. A thyroid Research Centre has also been set up at Namchi for diagnosis, treatment & research in Iodine Deficiency disorders.
Under the National Programme for control of blindness, free cataract operations are performed at STNM hospital.
Under the National Malaria Eradication Programme, fortnightly Domicillary Visits are made by Surveillance workers to detect fever cases and give treatment for the same. Spray activities to destroy the malaria vectors are carried out twice a year. Residential house including cowsheds and other structures are sprayed. Blood samples are also collected from fever cases to detect the cause. Over theyears the incidence of malaria has been gradually brought down.
The prevention of Food Adulteration Act. No. 37 of 1954 has been extended to the state of Sikkim from 1.4.79 vide Govt. of India Notification No. P. 15024/7/76 PH(F&N) and was enforced w.e.f. 4.5.79. The drugs and cosmetics Act, 1940 (23 of 1940) and rules 1945 has been enforced in Sikkim from 15th Sept 1984. Regular inspection by the Foods & Drugs Inspectors under these Acts, and analysis of food and drug items has reduced adulteration to a large extent.
To bring about a better health status among mothers and children. Nutrition programme is being implemented throughout the state. There are two components of the programme viz. Supplementary Nutrition Programme and Mid Day Meal Programme. Under the SNP, Pre-School children and Pregnant & Nursing mothers are provided with ready to eat food. Under MDM, school children up;to class III are also fed with the ready to eat food. Besides these, demonstrations on preparation of low cost locally available nutritions recipes are conducted by the staff of the Nutrition cell.
Morbidity due to diarrheal diseases has been the highest as compared to any other diseases reported in the State. This has led to the implementation of the Diarrheal Disease control Programme. Under the Programme, Medical as well as Paramedical workers including mothers are trained on Oral Rehydration Therapy and diagnosis of dehydration case due to severe diarrhea. 108 Medical Officers, 277 ANM, 380 MPWs (male), 197 Aganwadi Workers, 2295 mothers have so far been trained on oral rehydration therapy.
Under the programme, free distribution of oral rehydration salt packets are also done for severe cases through all the hospitals, PHCs and PHSCs. Theses packets are taken even to the doorsteps of the rural people through trained health guides. About 30,000 packets are distributed annually.
To set up a base line date for further improvement in the delivery of health services in the State as well as to bring about a better nutritional status of the mothers and children, health and nutrition status surveys have been completed in the State seperately. The reports of these two important surveys have been published. Another Survey on Public Health Sanitation, water supply and health status of the people is in progress.
School Health Programme which was initiated in the year 1979 was made more comprehensive in nature and coverage. It covers students from class I to V with services like immunisation, health check up, Health Education and Teachers Training. Every year Primary School Teachers are also trained under this programme. Similarly, 15 Schools under Rangpo PHC have been taken up under National School Health Programme. Special School Health Chechup Scheme was launched from 22.7.96 to 27.7.96 for screening of all Primary School Children for minor ailments like anaemia, nightblindness, pyoderma, scabies, dental caries etc. The scheme was launched in co-ordination with Education Department and 873 School and 94,707 children were screened under the special School Health Scheme of which 51,324 children were treated in the health centres and hospital in the State.
As the stress has been more on preventive aspects, all Health Programmes including National Programmes are being suplemented through regular health education activities like Health Camps and Orientation Training Programmes. Efforts are also being made to educate and motivate the people in better health care through mass media like film shows, literatures, exhibitions, etc.
Pulse Polio Immunisation Programme have been organised throughout the State on 9.12.95, 20.1.96, 7.12.96 and 18.1.97, during which time children below 3 yrs. and above 3 yrs. where immunised against poliomyelitis. The obhective of the Programme is to eradicate Poliomyelities by 2000 AD. Such programme is to continue till 2000 A.D.
De-addication-cum-treatment Centre for drug addicts and alcholics is under construction at STNM Hospital, Gangtok.
With the intention of improving the educational opportunities and health services in the State and to facilitate the establishment of Institute of Medical Science for Medical, Dental, Nursing Pharmacy and other Allied Health Training at the under graduate, graduate and post graduate levels, Sikkim Manipal University of Health, Medical and Technological Science Act. 1995 has been enacted.
To regulate the setting up of Private Hospitals, Nursing Homes and other centres catering to Diagnostic, Investigative and other health care services in the interest of Public Health, the Sikkim Clinical establishment (Licencing and REgistration) Act, 1995 has also enacted.
Review of the basic Health parameters at the end of the VIIIth Five Year Plan indicate that there has been a significant impact in the health status of the people of the State through the years. However, a drasic decrease in the death rate brought about by the improvement in the Health delivery system has led to a high growth rate of population in the State. This calls for a more vigorous implementation of the Family Welfare Programme which we hope to achieve through the present policy of the Government of India of the Target Free approach.
Much needs to be done to further improve the quality of services to bring about better improvement in the status of life expectancy, reduction of infant mortality rate, reduction in birth rate and death rate and contain the growth rate of population. This is to be achieved by providing qualified, trained and dedicated medical and paramedical personnels, necessary equipments and support.