Health
State of Environment Report in Tripura 2002

Health and environment have been interlinked in more than one area of study. While human development index, as adopted by UNDP, consider non-economic indicators to assess development, health indicators can clearly indicate the quality of air, water, sanitation, noise vis-a-vis state of human health.

13.1 Health Care Facility

The State of Tripura, till date, seems to suffer significantly in terms of health care delivery system. The available data of 1999-2000, published by Directorate of Economics and Statistics in Tripura shows that total number of Public Health Clinic is only 59, total number of Hospitals 28 and dispensaries 621. While these figures have improved between 1985-2000 and may not sound alarming, the figures for available number of doctors (905), nurses (920) and midwives (95) shows the extreme inadequacy of health care delivery. While Indian figure for doctors stands at 48 per 100,000 persons, for nurses 58 per 100,000 persons and midwives 30 per 100,000 persons, the respective figures for Tripura stands at 32, 32.9 and 3.6 per 100,000 persons (Table-89).

Table- 89 : Health Care System 1999-2000

Year

No. of PHC

No. of Hospitals

No. of Dispensaries

No. of Doctors

No. of Nurses

No. of Midwives

1985 *

39

    12

NA

NA

NA

NA

1999**

68

     24   

  

538

905

920

95

 [Source: *State of Environment in Tripura Report 1989. **Directorate of Economics & Statistics and  *** Figures in parenthesis for the year 1999 supplied by Directorate of Health, Govt. of Tripura]

13.2 Birth Rate & Death Rate

The data with regard to the estimated birth and death rate however shows a better trend in Tripura in spite of inadequacy of heath care delivery system. In rural areas, the estimated number of birth rate stands at 18.2 and death rate at 6.1 per 1000 persons, but in urban area the corresponding figure stands at 14.8 and 5.4 respectively. The combined figure of rural and urban sector stands at 17.6 and 6.1 as against All India figure of 28.7 and 9.2 (Table-90).

Table- 90 : Estimated Live Birth rate and Death rate (per 1000 persons)

Sector

Birth Rate

Death Rate

Tripura

India

Tripura

India

Combined

17.6

28.7

6.1

9.2

Rural

18.2

30.4

6.2

10.6

Urban

14.8

23.5

5.4

5.7

[Source : Office of the Register General, India, 1999]

The infant mortality rate for rural and urban sector stands at 50 and 39 respectively (per 1000 persons) and combined figure stand at 49; the corresponding figure for Indian average is much higher at 77,45 and 72 respectively (Table-91)

Table- 91 : Infant Mortality rate in Tripura and India (per 1000)

State/Country

Rural

Urban

Combined

Tripura

50

39

49 (42)*

India

77

45

72

                    

[Source: CSO from Dept. of Family Welfare, Ministry of Health and Family Welfare, 1998, * Figure within parenthesis denote 1999 data supplied by supplied by Directorate of Health, Govt. of Tripura]

13.3 Occupational Health Hazard

The data on occupational health hazard could be of vital importance in assessing impact on health of different developmental sectors. Unfortunately no such data are available. Recent efforts of at least one large enterprise, Indian Oil Corporation (IOC) to assess the risk and disaster management in three of the IOC operational site in North Tripura (as a part of assessment of 11 sites in North East India) by the Calcutta based Centre for Study of Man and Environment may provide a possible projection of any accidental disaster related health hazard.

The total registered factories in Tripura, as per Directorate of Economics and Statistics handbook, (1999-2000) stand at 2582 of which 1349 factories are recorded as Notified factories; total workers employed in 2582 registered factories number 30,012. Obviously categorization of operation of these factories in Red, Orange and Green categories and regular check up by Health Inspectors from State Labour Department could provide indicative data on possible occupational health hazards.

Among the industries and allied activities in the State posing substantial health hazard including death are Ferrous Metallurgical, Power generating, Acids & alkalis Drugs & Pharmaceutical, Distilleries & Breweries, Paints & Pigment, Leather Tanning, Synthetic Resin and Plastic, Highly Flammable Liquid & Gases and Lead. Number of hazardous units is 28 including 11 power-generating units.

13.4 General Health Profile

The general disease profile of the State over last 15 years up to (1999-2000) clearly indicates highest incidence of diarrohea followed by malaria. The comparable data for 1985-86 and 1999-2000 for bronchial diseases and cancer are not available but the bronchial disease figure of 1,18,787 in 1997 and cancer related figure of 17,874 in 1999-2000 calls for serious concern.

While separate data are available for cholera (16,186) and tuberculosis (1435) for the year 1985; nil data for cholera for subsequent years appear questionable; for tuberculosis the data for 1999-2000 stands at 463 including indoor and outdoor patients.

Current data on typhoid and measles may call for better immunization programme. Of the other disease incidences of leprosy, viral hepatitis and polio appear to be infrequent. Table-92 Provide a decadal change profile between 1985 to 1993-94 and also provide the latest health data including for some additional diseases.

Table- 92 : Disease Profile of Tripura

Disease Category

1985 (1)

1993-94 (2)

No. of Cases

No. of Death

No. of Cases

No. of Death

T.B.

1435

30

0

0

Leprosy

N.A.

N.A.

208

0

Malaria

N.A.

N.A.

11,680

16

Japanese Encephalitis

58

0

0

0

Filaria

N.A.

N.A.

N.A.

N.A.

Poliomyelitis

75

1

8

0

Viral Hepatitis

277

8

139

8

Cholera/Gastroenteric

16,186

22

0

0

Dysentery/Diarrhea

50,668

38

92,653

71

[Source : (1) State of Environment in Tripura, 1989 p. 99 (2) Health Information of India, Central Bureau of Health Intelligence, DGHS  Min. of Health & Family Planning, New Delhi]

The prevalence of dysentery appear on the rise when compared with the past figure of 1985 and that of 1993-94 and 1999-2000; during 1985, 2.4% of the population was suffering from this disease, while in 1993-94, more than 3.3% of the population are reported to have been affected by this water borne disease; the figure stands at 3% in 1999-2000. Data for 1998 on the total morbidity supplied by Directorate of Health indicate 3,72,436 indoor patients and 95,760 outdoor patients.

Improvement of the drinking water quality becomes an urgent necessity; to offer remedial measure; treatment of water and improvement of distribution system become essential.

13.5 Family Health

Tripura, as per National Family Health Survey (1993) has experienced considerable decline in the fertility in recent decade. During 1990-92, the total fertility rate (TFR) in the State was 2.7 children per woman, 21 percent lower than the national average. The stabilization of population can have a positive effect of more women processing family planning; in Tripura 56 percent of currently married women are reported to resort to such practice but only 29 percent adopt modern methods (National Family Health Survey Summary Report, Tripura, 1993).

On the other hand infant mortality rate remains high in Tripura, 1 in 13 children dying before they reach the age of one and 1 in 10 children dies before reaching age of five. This figure goes against Human Development programme and demands a better health care service to reduce infant and child mortality. The picture becomes more clear from the fact that for 35 percent births mother do not get antenatal care. Most babies (69 percent) are delivers at home and only 33 percent of deliveries are attended by nurses and midwives. This can be corroborated with extremely inadequate figure for such categories of health care personnel as mentioned earlier.

Coming back to UNDPís guideline to assess Human Development, nearly half of the children being underweight and 46 percent remaining stunted, show an alarming nutritional deficiencies.

While child Survival and Safe Motherhood programme (CSSM) adopted in the 8th Five Year Plan (1992-97) targeted to lower an infant mortality rate of 50 per 1000 live births, the figure for Tripura during 1988-92 was 76 per 1000 live births. Similarly the target for under five mortality was fixed at 70 per 1000, the figure for Tripura during 1988-92 stood at 105 per 1000. The crude death rate target of 9 per 1000 population was never achieved- the figure stood at 12 per 1000 in 1991-92. The biggest lapses can be noted in the services for antenatal case and deliveries during pregnancies; against a set target of 100 percent coverage for both, the services, women in Tripura received 65 percent antenatal care and 33 percent delivery related services during 1988-92. The population stabilization can be better achieved with 75 percent couple protection rate as against 56 percent recorded in Tripura.

However, the reader may refer back to the Table-91 showing the figure of 1999 regarding infant mortality rate per 1000; it shows a definite improvement from 1992 period (76 per 1000 to 49 per 1000). The recent figure for crude birth and death rate per 1000 (as given earlier) also indicates a significant change in the trend.

13.6 Family Welfare

Four different methods of family programmes are being carried out by Govt. of Tripura. The data available for the year 1995-96 to 2000-2001, show that in each of the four programme namely (i) sterilisation, (ii) IUD, (iii) C.C. Users and (iv) Oral pill users, percentage of achievements against target are declining. While in 1995-96 97% was achieved in sterilisation programme, 151% was achieved in IUD programme and 543% was achieved in oral pill programme, the respective figure for the year 2000-2001 stands at 61%, 81%, and 57%. Even for C.C. users the achievement of 97% of 1998-99 decline to 36% in 2000-2001. As such the implementation of family welfare programme needs a serious review before the initiation of 10th Five Year Plan.

Besides these, the State Government has so far been able to implement number of family welfare programme under National Programme Schemes till 1999-2000. These are : National Family Welfare Programme, National Malaria Eradication Programme, National Programmes for Control of Blindness, National Tuberculosis Control Programmes, National Iodine Deficiency Programmes, National AIDS Control Programmes, National cancer Control Programmes, Universal Immunisation Programmes, Oral Rehydration Therapy Schemes, National Leprosy Eradication Programmes, Special School Health Check-up Schemes for Primary Children, Pulse Polio Immunisation Programmes, Village Health Guide Schemes, Prevention of Food Adulteration Act and Sexually Transmitted Disease Control Programmes.

No data is available on the targeted programme, actual achievements and slippages with regard to the above named projects.

 
top