A Roadmap for the Health Sector in J & K

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A visit to almost any hospital in the Kashmir valley immediately makes it clear that something is seriously wrong. The stench is often unbearable, the buildings dilapidated and the infrastructure is in shambles.  Kashmir is coming out of the shadow of violence that hit it at during the 90s when the State lost its writ and all the institutions of the State began to reflect that reality. Education, administration, healthcare –everything was severely affected. But in the last one decade, with low levels of violence, the State has again started to regain authority and institutions have begun to function more normally than in the previous decade.

But despite this turnaround in the situation in the valley, the health sector, not only in the valley but throughout the state of J & K shows signs of decay and sickness. The reasons are many: Administrative apathy, indifference, political interference, non accountability, corruption etc are just a few of the vital reasons that have led to this decay. The health sector in the State is still predominantly in the public sector and all big hospitals and primary health centres and district hospitals are Govt run. The private investment in the health sector in the state is bare minimum and hence the majority of patients utilize the services of the Govt run hospitals. In the previous decade, the lack of private investments in the health sector, most notably in setting up big hospitals, could be attributed to the political violence in the valley but there are other reasons now for the lack of this private investment and hence lack of growth of the health sector in the State.

Most doctors in the State working in Govt hospitals have completed their education from the various medical colleges in the State. These are Govt owned colleges and provide subsidized medical education to their students. It would be logical to expect the State Govt to have a proper policy and framework in place where the doctors coming out of these colleges and absorbed in the Govt service have to spend a minimum first few years of their service in rural areas.  J and K state has a majority of its populace living in rural areas where health services like hospitals, laboratories, diagnostic centres etc are lacking. Go to any interior part of the State or even visit a district or a sub district hospital or a primary health centre in a rural area, an acute shortage of medical professionals, most notably doctors and specialists will strike you. Most doctors in the State don’t like working in rural areas since they want to establish a private practice in the cities like Srinagar and Jammu. In the absence of a clear policy from the Govt, the health sector in the rural areas suffers with the result that many people in these areas are either denied access to proper health care or have to rush to the bigger hospitals in Srinagar and Jammu to get treated. This is not only inconvenient but also entails higher financial costs. This puts additional burden not only on the doctors in these bigger hospitals but also puts a strain on the limited facilities available there. Since most doctors don’t want to work in rural areas, doctors who can’t influence their transfers are often forced to spend more time in rural postings than they should normally have. The Govt needs to rework a proper policy in terms of undoing this imbalance.

Issues relating to allowing or not allowing Govt doctors conduct their private practice also complicate the situation. Presently doctors working in the Sheri Kashmir Medical Institute and is affiliated hospitals are not allowed to carry out their private practice. They are instead paid a non practicing allowance, but despite that some doctors still carry out their private practice. The Govt should make sure that the offending doctors are properly penalized. Doctors working in SMHS and Associated hospitals are allowed private practice. This has lead to a conflict of interest where patients believe that such doctors don’t do justice to their work in the Govt hospitals and their main focus and concern remains their private practice. Some of these doctors also work part time in the smaller private hospitals after their working hours in the Govt hospital are over. This has given rise to a situation where such doctors want to have best of both the worlds: the Security of a Govt job along with the economic incentives of carrying on a private practice.

The non availability of full time doctors and other medical professionals in the private sector is perhaps one of the main reasons for lack of any worthwhile private investment in the health sector in the State. Running a big and/or a multi specialty hospital needs doctors and medical professionals who are available full time. Any wannabe private investor would like to have doctors and other medical professionals who would commit their time in working at these hospitals. With the present policy, that is not possible and hence one cannot expect big private hospitals to come up in the State. The Govt needs to do away with this anomaly in a time bound manner and stop allowing doctors working in the Govt hospitals, in a gradual manner, to carry on their private practice. These doctors need to be compensated by way of a non practicing allowance. The Govt can simultaneously encourage private investments in the health sector in the State. Over a period of three to five years, when this policy will be fully implemented, one can expect a better choice not only for the patients but also for the medical professionals in choosing their career. This would also create employment opportunities for new doctors, technicians, nurses and other related professionals. Many patients who have to go outside the State now for specialized treatment would perhaps need not take that journey. Many doctors and nurses from the State working in other States in India or overseas can also think about returning to the State to take up jobs. If this policy is properly thought out and implemented, it can have long term positive impact on the health sector in the State.

Doctors working in the State are promoted to senior teaching and administrative posts based on their seniority. Since medicine is a knowledge based industry, promotion policy which takes not only seniority into consideration, but the ability and efficiency of the doctors also, needs to be implemented. Doctors should be promoted not only based on their seniority, but also by evaluating them thoroughly through examinations. A small weightage could be given to their seniority in the promotion process. This could lead to a system which respects the merit of doctors and can lead to better results and an efficient health care system in the State.

All Govt hospitals receive supplies of certain medicine and drugs after awarding tender to the lowest bidding supplier. These supplies need to be constantly monitored and surprise tests conducted in reputed labs to check the quality of medicine being supplied. Companies which fail these tests should be penalized and banned from any further supplies and bidding process. The practice of allowing medical representatives inside the Govt hospitals and making a pitch for their products should be completely stopped. This leads to a conflict of interest and can also lead to unethical practices.

In the last few decades, Kashmir valley has been notorious for fake and spurious drugs. During the years of militancy, many unscrupulous elements took advantage of the uncertainty and supplied fake and spurious drugs in the valley. Also during those years many pharmacies and pharmaceutical distributors set up shop without necessary approvals. Now that the State has regained its authority, it needs to crack down on unauthorized retail medical shops and distributors and also conduct regular monitoring of the medical supplies within the State.

Barring the capital cities of Srinagar and Jammu, there are hardly any pediatric and maternity hospitals in any district headquarters. This puts huge pressure on the hospitals in these two cities and also puts the doctors and medical staff working there under tremendous burden. It goes without saying that the Govt needs to invest substantially in the health sector in the rural and semi urban areas.

A willing and caring State administration can check the rot in the health care system in the State and turn this crisis into an opportunity. 

Doctors working in the State are promoted to senior teaching and administrative posts based on their seniority. Since medicine is a knowledge based industry, promotion policy which takes not only seniority into consideration, but the ability and efficiency of the doctors also, needs to be implemented. Doctors should be promoted not only based on their seniority, but also by evaluating them thoroughly through examinations. A small weightage could be given to their seniority in the promotion process. This could lead to a system which respects the merit of doctors and can lead to better results and an efficient health care system in the State.

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