Health sector in Assam: Paradigm shift

Gautam Ganguly

(gautamganguly2012@gmail.com)

Much to the relief and euphoria of the inhabitants of an otherwise backward Dhubri district, in terms of per capita income and human index parameters, a government medical college has been formally set up in Dhubri town situated in the western part of Assam bordering Bangladesh. In consonance with unprecedented flurry of benevolent, people-friendly works and schemes being implemented at the grass-root level with remarkable speed ever since the installation of the present Assam Government in May,2021, the ninth medical college of the state with 100 seats for MBBS students has begun, heralding an era of hope and promise in quality medical treatment and education not only to Dhubri but to the inhabitants of the lower Assam districts as whole.

A casual glimpse at the history of medical education reveals that till 2008, there were only three medical colleges in Assam. While the iconic Berry White medical school at Dibrugarh was upgraded as the Assam Medical College as back as in 1947, the Gauhati Medical College was established in 1960. The Silchar Medical college had started functioning from 1968. For long 61 years, these three medical colleges were producing a paltry 391 medical graduates annually, falling far short of requirement of treatment by qualified Allopathic doctors to the growing population of the state at affordable price. Further, the acceptable 'doctor-patient ratio' prescribed by WHO (World Health Organization) is 1:1,000. Needless to say, the ratio in Assam was lopsided for long. Assam had one doctor against 1,800 patients till 2016.

To put the record straight, however, over all doctor-patient ratio in India is 1:1,655 as against WHO norm of 1:1000 (Source: National Medical Commission).

To meet the widening gulf of doctor–patient ratio, the government of Assam had started working towards a solution and targeting to reach the required ratio. Under the dynamic leadership of the then Health Minister and present Chief Minister, the government of Assam had embarked on the challenging task of establishing government medical colleges with a view to produce more medical graduates and to take healthcare services to the doorstep of the hoi-polloi. After waiting agonizingly for nearly over five decades, the Jorhat Medical College was established in 2009 with 125 undergraduate seats to set the ball rolling for establishment of more medical colleges for the benefit of the beleaguered residents.

The Fakhruddin Ali Ahmed Medical College at Barpeta was set up in 2011 and the Tezpur Medical College in 2014 with 125 undergraduate seats in each. With the establishment of the Diphu Medical College and Lakhimpur Medical College in 2019 with 100 seats each, a new era in medical education and treatment had begun. Simultaneously, existing capacity of undergraduate seats of the Assam Medical College in Dibrugarh and Gauhati Medical College were augmented from 170 and 156 respectively to 200 each. The seats in the Silchar Medical College rose from 65 to 125 undergraduate seats. Consequently, from a meager figure of 391, the state has been producing 900 medical graduates from 2017 onward, a phenomenal stride within a short span. Enhancement of seats facilitated better treatment under rich infrastructure, besides opening opportunities for the bright students of the state to fulfil their dream of becoming doctors and serve the people.

Correspondingly, postgraduate seats were enhanced in three medical colleges and newly established colleges. As on date, Assam is producing approximately 675 postgraduates and diploma holders in the Allopathic stream in all familiar disciplines like medicine, surgery inclusive of all other gamut of specialized streams like ENT, pathology, pediatrics, gynaecology etc.

Interestingly, a casual comparison with the medical scenario in West Bengal showcases the clear advantage for Assam. As per the 2011 census, West Bengal's population is 9.13 crore, three times more than Assam's population. Till 2016, West Bengal had nine government medical colleges five of which were in Kolkata and four outside Kolkata city. These four outskirt colleges were at Siliguri, Burdwan, Bankura and Midnapur. Around the same time, there were six government medical colleges in Assam in 2016, five of which were outside Guwahati. Therefore, the load of patients medical college-wise reveals the ratio stood at 0.87 and 1.923 in Bengal and Assam respectively per crore population. Out of 20 medical colleges in Bengal , twelve of these medical colleges have come up after 2012. Far-flung colleges in Coochbehar, Raiganj, Nadia, Murshidabad, Malda etc., have come up in 2019. Viewed from this perspective, Assam is certainly catering to more afflicted persons across the length and breadth of the state with skilled manpower and enriched infrastructure.

Much has been written about high MMR ( maternal mortality rate) in Assam. As per figures and statistics of Registrar General of India (SRS bulletin), India has made significant progress in reducing MMR from 556 per lakh live births in 1990 to 103 per lakh births in 2017-2019, a whopping 81% decline. Nine States like Kerala, Maharashtra, Telengana,, Andhra Pradesh ,Tamil Nadu, Gujarat, Jharkhand, Karnataka and Haryana have achieved the ambitious target of MMR of 100 per lakh live births in 2020. The rest of the states, including Assam, are the poor performing states as per record. However, Assam has been maintaining a consistent declining rate in MMR in comparison to many other states. In 2017-18, Assam has recorded 7.29 percent decline in MMR. Relentless effort is on to reduce the maternal mortality rate for over a decade. In fact, Assam's present poor plight is due to previous poor record of MMR up to 2005. To use an analogy, Assam's poor MMR is due to the "original sin" committed by a set of previous generation of administrators. Assam has recorded 99 point drop in MMR earlier.

With equal emphasis given to upgrade existing Ayurvedic college and establishing new colleges as a part of 'mainstreaming 'Ayush', phenomenal and all-round developments are being carried out at breakneck speed, vindicating the saying that "action speaks louder than words".