From Naxal Belt to National Stage: Sukma’s Health Care Revolution

Red Reckoning

Part 3

Our five-part series examines the rise and decline of India’s Maoist insurgency, once described as the country’s “greatest internal security threat” and the uneasy transition from conflict to control in its last strongholds.

In the rugged terrain of Bastar, long defined in the national imagination by security bulletins and encounter reports, a significant transformation is underway. In Sukma district, one of the most acutely Naxal‑afflicted and logistically challenging pockets of Chhattisgarh, a health‑care revolution is rewriting the narrative of violence and outlawry. Three health centres in Sukma have just been certified under the National Quality Assurance Standards (NQAS) by the Ministry of Health and Family Welfare, Government of India. Far more than a mere administrative success, this is a civilisational signal that the state’s development‑security‑service tripod is finally grounding itself at the grassroots.

The three facilities that have earned the NQAS seal are Primary Health Centre Buderi, Ayushman Arogya Mandir Gagpalli, and Ayushman Arogya Mandir Christianram. Each is a small node in the primary‑health‑care architecture of a district where the nearest city hospital can be several hours away by road, if the roads exist at all. Yet, these centres have crossed 70 percent on all eight NQAS domains of service delivery, patient rights, infection control, clinical care, hospital management, support services, documentation, and patient‑centred behaviour.

Quiet Governance

Sukma’s story is not just about infrastructure or audits; it is about political will and administrative persistence. In the last few years, the perception of Bastar has slowly shifted from ‘insurgency zone’ to ‘development‑frontier.’ The state government, led by Chief Minister Vishnudeo Sai, has treated the district as a priority for both security and social‑sector investment. The NQAS validation is the visible tip of that iceberg: behind it are upgrades in roads, communication, and power; the steady deployment of medical and paramedical staff; and the creation of an environment where health workers can function without fear of being targeted.

This is crucial because Naxal‑affected areas used to suffer from a double deficit: physical access and trust. Villagers were often cut off from district hospitals, and when they ventured out, they sometimes viewed the state’s health system as part of the same ‘system’ they were being coerced or alienated from by Maoist cadres. By bringing certified, quality‑assured care closer to their homes, the administration is slowly rebuilding that trust. The fact that these centres are now being held up at the national level sends a clear message: the ‘Naxal belt’ is not a dark zone excluded from India’s development map, but a terrain where good governance can and must be tested.

National Quality Assurance Standards (NQAS) are the Union government’s benchmark for quality in public‑health facilities across India. They are not cosmetic checklists; they cover eight core domains, each of which corresponds to a real‑world experience the patient has inside the hospital. From whether the facility is open and staffed to whether infection‑control protocols are followed, from how medicines and diagnostics are managed to how staff treat patients with dignity, NQAS measures the entire patient journey. Passing 70 percent on all eight standards is no small task, especially in remote, under‑resourced areas where absenteeism, stock‑outs, and security threats are constant.

The NQAS certification has a practical incentive layer: certified facilities become eligible for financial incentives under national health‑mission schemes. This additional funding can be used to expand outpatient departments, upgrade minor operation theatres, strengthen labour‑and‑delivery services, and improve diagnostic capabilities. In Sukma, this means that the money can be deployed to plug very tangible gaps, better ambulances, functional X‑ray and ultrasound machines, or more reliable electricity and cold‑chain storage. The result is not just ‘better hospitals’ in bureaucratic terms, but shorter travel times, fewer avoidable referrals, and higher confidence among villagers when they seek care.

Hygiene Culture

Behind the stamp of NQAS lies years of painstaking work. In Sukma, district officials have instituted a regime of continuous monitoring. Regular inspections, surprise checks, and periodic audits have become the norm, not the exception. Simultaneously, the supply chain for medicines and diagnostics has been tightened so that basic drugs and routine tests are available even when transport routes are disrupted. This logistical discipline is as important as any medical protocol: an NQAS‑certified facility is meaningless if it cannot retain personnel or keep its pharmacy stocked.

Equally important has been the institutionalisation of infection‑control and hygiene. In a remote tribal setting, where septic complications and water‑borne diseases are perennial threats, simple measures: hand‑washing stations, proper biomedical‑waste disposal, safe‑delivery protocols, and standardised sterilisation norms can dramatically reduce maternal and neonatal mortality. The NQAS certification signals that these centres have not only installed these systems, but also internalised them as part of daily practice. Staff behaviour with patients, respectful, courteous, and transparent has also been made a formal criterion, which is critical in a context where many villagers feel intimidated by even the smallest health facility.

The transformation of Sukma’s health centres has also been shaped by the Nyad Nellanar scheme, a targeted development initiative that focuses on the most backward and conflict‑affected areas. Under this scheme, the district administration prepared a special action plan aimed specifically at lifting these centres to NQAS standards. The plan was not generic; it addressed local constraints, shortage of specialists, difficult terrain, security‑related delays in supply chains, and accommodation and safety concerns for medical staff. By strengthening infrastructure, plugging manpower gaps, and ensuring steady availability of drugs and equipment, the administration built a foundation on which the NQAS certification could rest.

This is where the ‘Sukma model’ becomes instructive beyond Chhattisgarh. It shows that conflict‑affected districts are not hopeless black holes but areas that require a focused, centrally‑supported, and locally‑adapted strategy. The Nyad Nellanar scheme, combined with NQAS certification, creates a dual incentive: the state gets a visible quality benchmark, and the villagers get tangible improvements in care. Over time, such a model can be replicated in other Maoist‑affected regions of Central and Eastern India, from Gadchiroli and Gadchiroli‑like pockets to Jharkhand’s tribal belts.

The narrative emerging from Sukma is a statement about the state’s long‑term strategy for peace and stability. In the past, counter‑insurgency rhetoric often treated development as a side‑effect of security. In Sukma, the evidence is tilting the equation as security gains are being leveraged to deliver social‑sector outcomes, and those outcomes are in turn reinforcing the legitimacy of the state. This is a critical evolution, because only when the state can deliver basic services can it truly displace the appeal of armed groups that fill governance vacuums.

From a national perspective, Sukma’s rise to NQAS certification is part of a larger story of India’s rural‑health‑care modernisation under the National Health Mission. While much attention is given to high‑end tertiary hospitals in metros, the real litmus test lies in the remotest primary‑health‑care centres. When a facility in an erstwhile Naxal hotspot can match national quality standards, it signals that the architecture of India’s public‑health system is maturing. It also suggests that the centre’s quality‑assurance push is being taken seriously by state bureaucracies, even in the most difficult terrain.

The immediate challenge now is consolidation and replication. The three certified centres in Sukma must retain their standards through annual reassessments. At the same time, the district administration, and by extension, the Bastar division must extend this template to other primary‑health‑care facilities. The goal should not be to stop at three NQAS‑certified centres, but to make quality certification a norm rather than an exception.

In the long run, Sukma’s health‑care story can become a template for a broader ‘development first’ doctrine in conflict‑affected regions. The state must continue to invest in roads, connectivity, and school infrastructure, but it must also treat primary health centres as strategic nodes of state presence. When a villager can walk or ride a short distance to a well‑stocked, clean, and respectful clinic, the idea of the state as a remote, hostile entity begins to dissolve. That is the quiet, but powerful, revolution that Sukma’s NQAS‑certified centres represent.

(The writer is a political consultant and an international relations expert. Views personal.)