DAMLOH INENKAWLNA SENSO LEH RETHEIHNA
James Miahlung
India-in hriselna lama chona(Challenge) hrang hrang a hmachhawn mekte zingah damlo inenkawlna senso hautak chho zelin mi harsa zawkte khawsak dinhmun a nghawng nasat hi health policy duangtute leh public health ngaihventute lu tihaitu liantak pakhat a ni. Damloh inenkawlna senso sang chho zel hi hriselna lama hmalakna atana sum dah(Financing) hniam te, primary health care leh invenna lam ngaihthah vang te, health insurance/healthcare scheme in mi rethei te a tuam zau tawk lo vang leh public health system chak tawk lo avanga mi harsa zawkten private health care system an pan thin vang te a ni deuh ber a ni.
Damloh nikhuaa mimal sum sen(Out of Pocket Expenditure/OOPE)sang lutuk hian India ram chhungkaw tam tak chu retheihna khurah a hnuk lut mek a. World Health Organisation (WHO)in 2023 March thlaa zirchianna a tichhuah “ India Health System Review” ah tarlan a nih danin OOPE avangin BPL chhungkaw zat chu 1993-94 ah maktaduai 26 atangin 2011-12 ah chuan maktaduai 54.5 ah a kaichho a, India rama chhungkaw zat pumpui atangin 17% te chuan an sum leh pai sen ral atangin 10% aia tam damloh inenkawl nan an hmang bawk.
Health policy expert Shyamkumar Sriram leh Muayad Albadrani in NSS, 71st round, 2014 behchhana an zirchiannaah OOPE avangin poverty headcount ratio(Ram chhunga mi rethei awm zat chhutna)a pun phah tih an finfiah a. Damloh inenkawlna atan mimal sum(Own pocket) hman a nih hmaa poverty headcount ratio chu 16.44% niin, hei hi damloh inenkawl nan mimal sum hman ral a nih hnuah 19.05% ah a chho a, OOPE avangin India ram chhungkaw maktaduai 6 leh nuai 47(2.61%) an rethei phah tihna a ni.
Mithiamte chhut danin OOPE zingah a hlawm lian ber chu damdawi leina senso hi a ni. Sakthivel Selvaraj, Habib Hasan Farooqui leh Anup Karan ten 1994 leh 2012 inkara Consumer Expenditure Survey leh NSSO Social Consumption: Health, 2014 behchhana an zirbingna atanga a lan danin 2011-12 khan chhungkaw pakhat OOPE pumpui atangin 67% chu damdawi lei nan a kal ral a, damdawi leina senso sang lutuk avangin chhungkaw maktaduai 38 lai chu retheihna khurpuiah an tlu lut a ni. Tin, damdawi ina inenkawlna/In patient care aiin in lama mahnia inenkawlna(Out patient care)avangin OOPE a sang zawk bawk niin chhut a ni a; in lama inenkawl dam theite zingah a khat tawka doctor rawn reng ngai inkaichhawn theih loh natna/NCD(Zun thlum, Cancer, Inhliam, etc) neiten sum an sen tam leh zual a ngai a phurrit (Disease burden)a sang bik hle a ni.
OOPE zirchianna dangin a tarlan danin OOPE pumpui atanga chhutin 30% leh 17% chu Cardiovascular disease/CVD-Stroke, Lung natna, etc. leh road traffic leh road traffic ni lem lo avanga hliam inenkawl nan a kal ral a. National Health System Resource Centre (NHSRC)tihchhuah Health Dossier 2021-in a chhinchhiah danin Mizoramah Daily Adjusted Life Years (Natna leh rualbanlohna avanga dam chen tur dam loa kum hloh zat chhutna) pumpui atangin 57.37% lai chu NCD vang nia chhut a ni. State statistical Abstract, 2021 in 2020 a mihring boral zat leh boral chhan a chhinchhiah danin mi 579 (17.45%)chu CVD kaihhnawih avanga boral an ni. Road Transport Ministry chhinchhiah danin 2022 ah Mizoramah road accident tum 133 thlengah mi 107 inhliamin mi 113 an boral a. Policy mumal tak duan a, hmalak a nih loh chuan NCD vangin sum leh pai tam tak sen ral a nih bakah nunna chan pawh an tam chho zel dawn niin a lang.
Mizoram chhung bik atan retheihna (Poverty) leh sum leh pai lakluh inchen lohna(Income inequality) zirchianna mumal a la tam lova, Economist JV. Nunchunga zirbingna(Thesis)“A Mathematical Study on Income Distribution and Estimation of Inequality with Reference to Mizoram” hi Mizorama sum leh pai lakluh inthlauhna zirchianna awm chhun a la ni rih mai thei. He zirbingnain a chhut danin Mizoram chhungkaw rethei sum nei tam lama mawngphah(bottom) 20% a awm te leh mi hausa top 20-a awm te sum neih zat leh sum lakluh punna(Growth rate) a inthlau hle. Bottom 20% te chawhruala sum leh pai lakluh(Average income) chu 1981 a 230.36 atangin 2006 ah 374.40 ah pung in, kum tin a punna rate hi 2.51% chauh a ni. Hetih lai hian mi hausa top 20% te sum lakluh erawh chu 1981-a 745.75 atangin 9364.43 ah a pung chho a, a punna rate chu 46.23% a ni. Sum lakluh inthlauhna tehna atana hman tlanglawn ber Gini Coefficient hmanga chhut pawhin Mizoramah hausa leh rethei intluk tlan lohna a nasa hle. 1981 ah Mizoram Gini Coefficient 10.11 a nih laiin 2006 ah chuan 31.27 a ni hman tawh a, kum 25 chhungin Mizo khawtlangah intluk tlan lohna a nasa hman hle tihna a ni.
India ram inthlan kaihhnawih(Electoral system) siamthat a nih theihna tura hma latu pawl Association for Democratic Reforms(ADR)chhinchhiah danin kumin assembly inthlanah candidate mi 174 zinga mi 144(66%)te chu crorepatis(Vaibelchhe khat aia tam hu rosum leh pai nei)niin, candidate-te hausakna chawhrual chu vaibelchhe 4 leh nuai 90 a ni a, candidate rethei zual top 10 a langten cheng sangkhat leh nuai khat inkar an nei. ADR data enin JV. Nunchunga zirchianna hi rei deuh tawh mahse Mizoramah hausa leh rethei inkar zauzia leh mi hausa zawkte hausak chak dan hriatthiam nan a la rintlak reng tih a lang a. OOPE in he intluk tlan lohna hi a rawn tizual ngei ang tih a rinawm.
Out of pocket expenditure-in Mizo mipuite a nghawng dan zirchianna mumal la awm lo mah se, mi hausa leh sum leh paia harsa lem lote ah nghawng a nei vak lo laiin mi harsa zawkte erawh nasa taka nghawngin chhungkaw tam tak retheihna belhchhahin hausa leh rethei inkar a tizau nasa hle ang tih a rin theih. Chhungkaw sum hman ral zawng zawng(Total consumption) atanga chhuta 10% aia tam damloh inenkawlna atan a kal hian Catastrophic Health Expenditure(CHE) tih a sawi a ni a, CHE hian mi rethei, BPL chhungkua leh BPL chung chiaha awm, APL chhungkua te retheihna a tizual a, thenawmte pawisa puk chawpin emaw ram leh ro(Assets) dang hralha damdawi inenkawlna senso phuhruk chhungkua an tam em em a ni. Shyamkumar Sriram leh Muayad Albadrani ten an chhut danin Mizoramah 2014 a CHE tawng chhungkaw zat chu 3.09% niin, kum 2018 ah chuan 6.9% ah an kai chho a, hemi kum hian Mizoram aia CHE dinhmuna ding chhungkaw tlemna state chu Meghalaya (1.83%) leh Nagaland(3.7%)te an ni.
Mizorama mimal damdawi ina inenkawlna senso hautak dan ngaihtuahin OOPE avanga mi rethei kan tam hi a mak lem lo. NSSO survey, 75th round, Key Indicators of Social Consumption in India: Health in a chhinchhiah danin 2017-18 khan ram pum huapin damlohna case pakhat inenkawl nan chawhruala senso zat chu sawrkar damdawi inah Rs. 4452 leh mimal damdawi inah Rs 31,845 a ni a. Mizoram bikah chawhrualin sawrkar hospital-ah Rs. 6,415 leh private hospital-ah Rs. 39,578 sen ral a ni ve thung a, India ram pum huapa senso(Average expenditure) aiin Mizoramah damloh inenkawlna senso a sang zawk a ni. State statistical abstract 2021 atanga lan danin sawrkar damdawi in ten outpatient leh in patient ngah zawk mah se, private damdawi ina in admit(in patient) an pung chak hle. 2017-18 khan private damdawi inten in-patient mi 45,940 an nei a, 2019-20 ah 81,204 ah pung in, 2020-21 ah chuan dam lo 1,18,897 lai chu private damdawi inah enkawl an ni a, private damdawi inah inenawl an tam chuan OOPE ah pawh a sang ang tih a rin theih.
Healthcare scheme/health insurance hi OOPE sang zel hmachhawnna hmanrua ni mah se, healthcare scheme ah OPD senso bill theih a nih chuan loh bakah cut a tam thin avangin mi retheite dinhmun a chhawk zangkhai vek chuang lo a. Tin, duh angin mipui a tuam zau tawk lo niin a ngaih ve theih bawk. NFHS-5, 2019-21 in a chhinchhiah danin Mizoramah member pakhat tal healthcare scheme emaw health insurance-in a tuam chhungkua chu 46.4% chauh a ni a, healthcare scheme chhungkaw tam zawk a tuam theih nan hmalak nasat a ngai ang.
Mizoramah sawrkar thar lo piang ta pawhin health sector-ah chona tam tak a hmachhawn dawn a, damlo inenkawlna senso sang lutuk avanga hausa leh rethei inkar zau zel tiziaawm turin health policy duangtuten ngaihtuahna sengin tum tak takna (political will leh administrative will tangkawp)nen health sector-ah danglamna thlen turin hma an lak a tul dawn a ni.
(Thu ziah hi mimal ngaihdan a ni)