Despite the tall claims made by different governments, health care sector in Jammu and Kashmir continue to underperform. There are a number of reasons that have jeopardized this most important sector in the state. Governments in general and health care institutions including the state’s health department have time and again tried to assure the people of quality services. But in the last one decade only poor performance have been recorded.
To begin with, one of the major crises in the state’s public health system is the dearth of manpower. There are, as a matter of fact, hospitals and health care institutions, but there is no one to take care of the patients. The number of patients is on the higher side compared to the number of doctors. This problem has marred the services in most of the hospitals, particularly the tertiary care hospitals where there is large influx of the patients. Vacant posts of professors, associate professors and assistant professors are not filled up on regular basis that directly affects the services. According to the Health and Medical Education (H&ME) report, in Government Medical College (GMC), Srinagar, of the 71 sanctioned posts of professors, 47 were filled but 24 are still vacant. Similarly, against the 79 posts of Associate Professors, 51 are filled and 28 are vacant and of the 106 posts of assistant professors, 60 are filled and 46 are vacant. In the Super Specialty Hospital (SSH), Srinagar there are 14 sanctioned posts of professors of which only one is filled in Gastroenterology and the remaining 13 are vacant.
Dearth of doctors is further aggravated by inadequate nursing staff in hospitals and treatment centers. As is witnessed every day in the hospitals of the state, the role of nursing staff is by no means insignificant or lesser than the qualified medicos. Whether it is administration of medicines or taking care of the patients, the nursing staff is a critical requirement in hospitals. While the state needs about 3200 qualified nurses, in Kashmir region we have only around 600 nurses as per the Directorate Health Services Kashmir.
The concentration of hospitals is also low in most of the districts due to which people are not able to avail health services on time or not at all. For instance in Tangmarg area there are around 50 villages where there is not a single primary health care facility. In peripheral areas and frontier districts it is the same story.
Health care infrastructure has some serious holes. District Hospitals lack facilities and machinery while as sub district hospitals do not have specialist doctors. There are no psychiatrists, clinical psychologists or even pediatricians and gynecologists in sub district and district hospitals. This causes patients to be shifted to few tertiary care hospitals. Only one district hospital has an ICU. Due to the absence of ICUs in district hospitals and also the ICU ambulances with associated staff, patients often are at high risk while they are being transferred.
At the policy level, the state does not have a clear health care policy, although the government and some bodies have expressed their opinion to have one.
Private practice of medicos has also had a dire effect on the public health in the state. In the premier institute medicos are paid Non Practicing Allowance. But the same is not provided to doctors of other hospitals. Doctors who do not receive NPAs have put forward their demands and have been seen as spending lesser time in the hospitals. Lack of accountability has put a question mark on the doctors services in different hospitals.
Then there is the problem of substandard medicines and drugs that are being pushed in the state’s markets. The government has a policy on the drug control and mechanism as well, but despite that it has not been able to get the state out of the spurious drugs menace.
Last year 300 new type primary healthcare centers (NTPHC) were established. But there condition is deplorable as they suffer due to shortage of manpower. District Hospitals were said to be converted into 500-bedded tertiary care hospitals but infrastructure posed problems. There is no communication between tertiary care hospitals and peripheral hospitals. On any patient that is being ferried, there is no clear picture as how the patient will be received till the arrival at the destination hospital. The helpline has never been promoted or strengthened. Trauma care facilities are confined to few hospitals and not to mention the AIIMS that has been proceeding at snail’s pace.
Bearing all these facts, it is impossible to have a rosy picture of state’s public health care system. People have been arguing and the government has also been supporting the argument that specialists should not leave the state and are bound to serve as government has invested on them. But at the same time, is it possible to convince the cream, the best of the doctors, to stay in the conditions that have been described above.