Health Yardsticks
According to the National Family Health Survey (NFHS) 1992-93, the percentage of children fully vaccinated in Meghalaya is very low at 10 percent and more than half of the children surveyed have received no vaccination at all. Furthermore, 46 percent of the children under age four are under-weight and more than 50 percent suffer from undernutrition. Besides, one of the most revealing of all indications of the well-being of children is the Under 5 Mortality Rate (U5MR) which stands at 87.

Plight of Women
Another important indicator, the Maternal Mortality Rate (MMR) which is 349 also highlights the poor state of affairs. The general health conditions of women are poor. The common ailments suffered by women are gastroenteritis, tuberculosis, malaria, anaemia and general debility. It is common to see many a women in the rural areas having as many as 8-10 children. Repeated and frequent pregnancies have been detrimental to the health of women. There is a deep-rooted belief in having large families. The debility due to pregnancies, extreme hard work and low nutritional levels have paved the way for an alarming rise in tuberculosis in women especially in the Garo Hills.
A significant portion of women do not receive any antenatal/postnatal care and a large percentage of deliveries are conducted by untrained birth attendants or relatives. The district hospitals, which act as referral hospitals, are distant and inaccessible to most villagers. When faced with obstetric complications like hemorrhage or obstructed labour, there is considerable delay in reaching these hospitals which results in maternal deaths.
Contraception is generally not popular but there are cases of women using indigenous medicines for the purpose. Women are also more likely to seek help from traditional practitioners for treatment of Reproductive Tract Infections (RTIs) and Sexually Transmitted Diseases (STDs) etc. Local health traditions, ‘DAWAI KYNBAT’ in Khasi Hills and ‘ACHIKSAM’ in Garo Hills are in fact practiced with a fairly good success all over the State. These practitioners enjoy a high degree of acceptance and respect and they consequently exert considerable influence on health beliefs and practices.

Under the HIV Grip
Though no up-to-date statistics are available, it is found that there is a rise in women testing positive for HIV especially in border trading areas, along the National Highways and close to armed forces cantonments. The National AIDS Control Programme had been taken up in the State for the first time in 1993. The total number of persons screened for HIV has remained at 14013 where 57 were found positive. The Comptroller of Auditor-General (CAG) report stated that blood samples of high-risk groups such as sex workers and intravenous drug users were not tested "to gather information on relevant parameters for estimation and projection of the epidemic". The report further pointed out that an expenditure of Rs. 8.07 lakh incurred by the Health Department on survey of sex workers and drug addicts conducted by the Health and Eco-defence society of Calcutta in October 1994 proved infructuous. Neither the survey report nor the recommendations were taken up seriously. Programme management for AIDS control remained ineffective due to non-creation of a Technical Advisory Committee for strengthening the technical and research capabilities. A massive social and governmental denial exists to conceal the problem of HIV/AIDS in the State. In such a situation the State will soon have to face the task of dealing with many full blown AIDS cases.

Consumer Consciousness
There is not a single consumer activist group which can give a fillip to the consumer movement in the State. Since inception in early 1990s, only 120 cases have been filed and had come up for hearing in the East Khasi Hills District Consumer Disputes Redressal Forum. For such a big district, this figure is too small. This can only be attributed to the general ignorance about the benefits offered under the Consumer Protection Act, 1986. The government probably thinks that its only duty is to create some awareness once a year on 15 March (the International Consumer Right’s Day). Apart from that very little is done to inform the consumer about his rights. The case of medical practice is very peculiar. Doctors doing private practices have no uniformity in their charges for consultation. Nursing homes are known to charge astronomical fees because there is no authority/legislation to oversee their functioning. Consumer grievances end up in individual protests and murmurs!

Health Infrastructure
The state has 9 Community Health Centres (CHCs), 85 Primary Health Centres (PHCs) and 324 subcentres but while such statistics reflect the quantitative aspect, the quality of the delivery system leaves much to be desired as 60-70 percent of these remain non-functional due to one reason or the other. People have realized the futility in depending on the government infrastructure, hence their greater reliance on indigenous medicines to cure the various ailments. A PHC is considered ‘established’ when buildings are constructed and staff positions created. Therefore, figures may show a substantial coverage of rural populations by PHCs and CHCs whereas in practice they languish without staff or equipment. 112 subcentres exist without any staff. While so much stress is laid on construction of buildings, no priority is given to health education which is completely absent. A large majority of people still believe that death occurs due to ‘God’s Will’.

Social Linkage
The State has to give more emphasis on improvement of accessibility and quality of service in the rural areas. Over 70 percent of the diseases are water related. Malnutrition and lack of potable drinking water leading to gastroenteritis are responsible for high mortality among children. The prevalence rate of communicable diseases is also a matter of concern.
As many of the health problems of the State are closely inter-linked with poverty and under development, the greatest health impact perhaps will come, not from medical interventions per se but from various health/non health initiates like safe water supply, sanitation and hygiene and women’s education (including health and nutrition education). There is a failure to realize that the wide range of diseases and mortality that the poor are routinely subjected to could be prevented by interventions such as livelihood promotion for the poor, increased agricultural productivity, sanitation and provision of safe drinking water, effective implementation of ICDS, PDS and so on. We can no longer ignore the reality of poverty and its associated deprivations. Though the government is making efforts to meet the major health needs of the population, there are some areas which are neglected or accorded a low priority in the government efforts which include:-

• links with the socio-economic process
• commitment to individual and community awareness building
• promotion of traditional/indigenous systems of medicine.

Areas of Action
The need to strengthen awareness in the community focusing on prevention especially at primary levels cannot be over emphasized. It involves forging of effective partnerships with traditional practitioners, village durbars, youth and women groups and above all the community at large. There is an urgent need to acknowledge the social basis of diseases. It needs also to be recognized that a wide range of equity-based state and social interventions would have a direct and even a critical bearing on public health. Health must ultimately constitute an integral component of the overall socio-economic developmental process in the State. It is therefore, necessary to initiate organized measures to enable proper development of these systems. Efforts also needs to be taken simultaneously towards a meaningful integration of the indigenous and the modern systems. An important beginning in this direction has been made with an ISM Cell recently set up in the Directorate.
What is needed is commitment on the part of the State, and resources, combined with a conviction of the paramount right of ordinary people to a healthy life and the due recognition of the enormous potential of their becoming partners of the State to realize this fundamental human right, a right which is very often lost sight of.

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