The hidden burden of dialysis in Manipur
- When survival costs too much -

Chinglemba Leitanthem *

In the lush hills of Manipur, where the rhythms of life are shaped by tradition and terrain, a quiet crisis is unfolding. Chronic Kidney Disease (CKD), a non-communicable condition that requires life-long treatment, is placing an overwhelming financial and emotional burden on hundreds of families across the State. For many patients, dialysis is the only option for survival—but it's one they can barely afford.

A comprehensive study conducted across 100 dialysis patients from various districts of Manipur paints a sobering picture. Despite the presence of National and State-sponsored health insurance schemes like PMJAY (Ayushman Bharat) and CMHT (Chief Minister's Hakshelgi Tengbang), the average out-of-pocket expense per patient stands at a staggering Rs 10,471 per month.

This figure includes both direct medical costs—like doctors consultations, medicines, and blood tests—and indirect costs such as travel, food, and caregiving.

A financial trap for the vulnerable

The economic implications are devastating, especially for low and middle-income families. Around 24% of patients surveyed live below the poverty line, earning less than Rs 3 lakh per year. Overall, families are forced to spend between 34% to 100% of their monthly income just to manage dialysis treatment.

One such case is a patient of 28 years old woman from Pangei, with an annual household income of just Rs 1.35 lakh. Her family, composed of eight members, survives on daily wage labor.

For her, each dialysis session—and the related costs of transportation, medicine, and lost income—translates into crippling financial pressure. Her story is not unique. From remote villages of Tamenglong, Ukhrul, Senapati etc to the suburbs of Imphal, patients face the same financial chokehold.

Geography as a barrier

The burden is made worse by Manipur's geography. Most dialysis centers, including prominent ones like Regional Institute of Medical Sciences (RIMS), and private hospitals such as Shija Hospitals and Research Institute (SHRI) and Babina Hospital are clustered in the capital city, Imphal. Patients from rural areas often travel more than 50 kilometers multiple times a week for treatment.

Some patient from rural areas has reported that travel expenses alone reach Rs 15,000 a month—five times higher than their urban counterparts. In a region where road conditions are challenging and public transport is limited, the logistical difficulties become just as daunting as the medical ones.

Patients from districts like Ukhrul, Churachandpur, and Senapati often begin their journeys in the early hours just to reach their dialysis centers on time, only to repeat the cycle days later.

With the current crisis in Manipur, those who have difficulties travelling to Imphal often turn to district hospitals (which lack adequate equipments and lower quality care), or even travel to neighbouring States for treatment—further increasing their expenses.

Insurance: A partial lifeline

While schemes like PMJAY and CMHT offer partial relief by covering the cost of dialysis sessions, they fail to address the bigger picture. Medications, which cost an average of Rs 6,037 per month, and blood tests (averaging Rs 765), are not covered. Nor are transportation costs or the opportunity costs of missed workdays. For daily wage workers, every dialysis session is a day without income.

For caregivers—often family members—it's the same story. Despite being enrolled in these schemes, 60% of patients reported exhausting their savings, 45% had taken loans, and 20% had sold assets like land or livestock. These are desperate measures, reflecting the inadequacy of current policies to provide comprehensive financial protection.

Systemic gaps in healthcare access

Manipur's healthcare infrastructure is simply not equipped to meet the needs of its CKD population. District hospitals often lack functioning dialysis units, trained nephrologists, or even enough dialysis machines. As a result, patients are funneled into over burdened urban hospitals or expensive private clinics. Even in public hospitals, long waiting times and equipment shortages are common.

The lack of trained personnel—including dialysis technicians and nurses—further strains the system. For rural patients, the only options are either to uproot their lives and move closer to treatment centers or to delay or skip treatment altogether—a deadly choice.

The real cost of dialysis: Beyond the hospital

The impact of dialysis on families goes beyond rupees and paise. It affects children's ability to attend school, the quality of nutrition in households, and the emotional wellbeing of caregivers. In many cases, the economic toll pushes families further into poverty, reinforcing a cycle of disadvantage.

Families often face a cruel trade-off : Should they spend their limited income on a parent's dialysis or on a child's education ? Should they continue treatment or sell the last of their live-stock to pay for medicine ? These are decisions no family should have to make.

The way forward

It's clear that incremental policy shifts are no longer enough. What Manipur needs is a bold and targeted approach: Establish Well-Equipped Dialysis Units in Every District Hospital –This will reduce travel time and costs for rural patients and help decongest urban hospitals.

Expand Insurance Coverage – Schemes like PMJAY and CMHT must be updated to include the cost of medications, diagnostics, and transportation.

Invest in Workforce Development – Training more nephrologists, technicians, and nurses is essential to ensure quality care acrossboth public and private sectors.

Deploy Mobile Dialysis Units – Especially in remote districts, these can serve as lifelines for patients with no other access to treatment. Strengthen Awareness and Simplify Enrollments – Many eligible families are unaware of their entitlements. Community outreach, especially in tribal and rural areas, is crucial.

Introduce Travel Subsidies and Nutritional Support – Additional financial aid for travel and food during treatment days can reduce the indirect burden on patients.

A Call for Compassionate Policy

Dialysis should be a treatment, not a trap. In Manipur today, it is both. The data is clear : Without intervention, CKD will continue to ruin not only lives but entire households. We must treat this not just as a health issue, but as a social justice concern.

As Manipur strides forward in many areas, let this be the moment where we also look inward—and upward—toward a more equitable, humane healthcare system. A system where survival doesn't come at the cost of everything else.