Uttarakhand: Combating non-communicable diseases among women

Uttarakhand, along with Chattisgarh, and Jharkhand will complete 24 years of its formation this November. Uttarakhand, like its counterparts has long suffered neglect since it was part of the larger state of Uttar Pradesh. The far-flung hilly districts remained deprived of even basic infrastructure including roads, water, electricity, health, and education. Subsequently, state has seen higher rate of out-migration, wherein men migrate in search of livelihood, often leaving women behind to shoulder the responsibility of agriculture, household, caring for the elderly, and children.

Among the three states, Uttarakhand has seen a rapid surge in non-communicable diseases (NCDs) amongst men and women, with women bearing the burden of poor health and inadequate healthcare facilities. The proportion of NCD-led deaths in Uttarakhand is 61.5% of all deaths, for Chhattisgarh it is 53%, and for Jharkhand 48%. Uttarakhand surpassed the two states in terms of mortality due to chronic respiratory diseases (23%), cancers (10.6%), and diabetes and kidney disorders (5.7%) in women. The burden of cardiovascular disease (CVD) led deaths in women is also as high as 22% in the state.

Ambient and indoor pollution is perceived as the topmost cause of CVD and CRD while also causing lung cancers. Indoor pollution affects women and children more as they are the ones who spend more time indoors. In Uttarakhand two out of five women reported using unclean fuel for cooking (National Family Health Survey-2019-2021); easily available and almost freely available bio-mass is the preferred choice. Additionally, the degraded air from the industrial districts of Kashipur, Dehradun, and Rishikesh has threatened nearly 30% of the state’s population. Deaths due to respiratory disorders in women of Uttarakhand has been 4% higher than men and more than 8% higher than chronic respiratory disorder deaths in other Indian women.

Uttarakhand has an estimated population of 1.15 crore, 30% of which is concentrated in the districts of Dehradun, Haridwar, and Udham Singh Nagar. The three districts in the foothills also have a higher concentration of major public and private health facilities. Primary health centres (PHC) are expected to play a critical role in providing healthcare services, especially in hilly regions, where frequent travel to foothills is difficult. PHCs play critical role in addressing the early onset of disease through screening, diagnosis, health consultation for disease management, and providing referral to higher health facilities.

Since 2017, the state has been successful in improving number of PHCs and doctors. Uttarakhand has 89% Primary health centres (PHCs) and up to 91% are staffed with doctors. However, only 49% PHCs have all-weather motorable roads, 17.5% PHCs have telephones, and only 24.1 % have computers. Except for the number of PHCs and the doctors staffing PHC’s, the shortage of para-medical staff such as lab-technicians, pharmacists, ANMs and nurses increased between 2017 to 2022. The shortage of ANMs increased from 1% in 2017 to 21.6% in 2021, whereas the shortage of nurses increased from 48.4% to over 60%.

As Uttarakhand lags in health services, takeaways emerge from the practices of the neighbouring state of Himachal Pradesh. Although Himachal Pradesh is facing similar challenges such as the steady growth of NCDs in women and a shortage of paramedic staff, the state’s commitment to improving health service delivery, and health infrastructure is spectacular. On an average, Himachal’s per capita spending on health between 2014-15 to 2019-20 has been ₹2,870, whereas Uttarakhand spent ₹1,740, a gap of nearly 60%.

Arounnd 96.2% of all rural PHCs in the Himachal are connected with all-weather motorable roads and all 553 PHCs have a facility for referral transport, a must in rough terrain. Along with the emphasis on strengthening health infrastructure, the state also focuses on rigorous screening of NCDs such as diabetes, hypertension, and cancers. As per the state’s Economic Survey 2022-23, Himachal Pradesh screened 17 lakh women for breast and cervical cancer, which is 45% of women in the state.

Given that every three out of five women in the state are suffering from at least one of the NCDs, the state can begin with rigorous door-to door health screening, followed by timely health interventions such as use of mobile health clinics to conduct diagnosis and health consultations. Nonetheless, it is high time that the state invests in its health sector, strengthens its primary health care along with referral facilities. Furthermore, close the gap of health providers and above all improve its health infrastructure. After all it’s the matter of women’s health which cannot be postponed or neglected, causing chronic suffering and disabilities.

This article is authored by Prajakta Pradip Shukla, research associate, CSEP, New Delhi.