Trends
Sikkim’s health standards have improved significantly over the
last 15 years. Better health and medical facilities have reduced the infant
mortality rate from 88 per thousand in 1988 to 51 per thousand in 1997, against
the national rate of 71 per thousand (see chart 2.5). The birth rate in 1997 was
19.8 per thousand and the death rate was 6.5 per thousand, which are lower than
the all-India average of 27.2 and 8.9 per thousand, respectively. Medical
services are free for almost everyone in the state, and food and medicines are
distributed at no cost to all inpatients in hospitals and primary health
centres. The state also pays for secondary and tertiary health care treatment
outside the state.
Issues
Despite the strides made in health care, there is a need for better family
health care. The child mortality rate of 32.12 per cent is far higher than
national rate of 11.1 per cent (1996). Female babies below the age of one year
have a far higher death rate (22.28 per cent) than male babies (15 per cent).
One reason could be the low rate of child immunisation: Only around 53 per cent
of children below the age of one year (both rural and urban) were immunised
against all six vaccine preventable diseases. Only 62 per cent of rural children
and 66 per cent of urban children below the age of five were fully immunised.
The female/male ratio (females per 1,000 males) is far below the all-India
figure. In the 1991 census the female/male ratio was 878 for Sikkim, compared to
the all-India ratio of 927. The sex ratio for Sikkim deteriorates steadily
between the ages of 30 and 59 to touch a low of 655 in age group 55-59 (chart
2.6). The death rate for rural women aged 15 to 50 years is extremely high
(43.85 per cent) compared to men (23.87 per cent) in the same age group (chart
2.7). A major reason could be a high maternal mortality rate (no data is
available to verify this) as natal care is still largely undertaken by untrained
people. Despite the numerous PHCs and staff, most of the deliveries take place
outside the health centres. Around 53 per cent of the deliveries in the rural
areas are carried out by relatives or untrained midwives. Further, 41.24 per
cent of the rural women and 22.91 per cent of the urban women do not receive any
antenatal care.
Alcoholism
is an emerging problem in the state. While it is difficult to put a figure
on how many people are alcoholics, consumption is especially high among
men over the age of 31. Experience elsewhere in the country has shown that
strong community efforts are generally more effective than medical interventions
to help people overcome alcohol dependence.
The detection and cure rates of tuberculosis (24.5 per cent and 58.6 per cent,
respectively) continue to be low, making it the primary cause of known deaths in
the State.
Administrative expenses
are high. The state exceeds the national norms on primary health centres
(PHCs) and primary health sub-centres (PHSCs) by 10 and
62 respectively. Staffing and operating costs are high, especially as many of
them function from rented premises. Thus for every rupee of health care
provided, the administrative expense of dispensing the care is more than
Rs 2.
In addition to excessive infrastructure within the state, expenses for treating
people outside the state are high.
Family health and preventive care need to be strengthened. Inadequate primary
health care is partly a result of the poor connectivity of many villages with
the nearest health centre. While medical services are free, often the facilities
are more than a day's journey away. The recent mandatory inclusion of a woman
doctor in every PHC should have a positive impact on women's health, but until
roads and access is improved, the effects will be limited. Improving healthcare
for infants and children, an important goal in itself, will also help reduce
family size.
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