Pvt Sector Missing, 97% Of Kashmir Healthcare Dependent On Govt

Srinagar: The maltreatment of a pregnant woman from a remote district at Lal Ded Hospital Srinagar, Kashmir’s only tertiary-care maternity hospital, on Friday has once again put the spotlight on the faulty referral system of maternity cases in Kashmir and other problems associated with the region’s health-care. 

The woman (Suraiya Begam of Moori village in northern Kupawra district) after being denied admission in the hospital, delivered baby, who could not survive, on the road just outside of the hospital. She had reported at the hospital after being referred by doctors from the district hospital in Kupwara, 90 kilometers away.     

Experts say that such incident would have never taken place had there been proper coordination among district health officials and the administration in Valley’s largest maternity hospital (Lal Ded). 

“On the face of it, it seems to be a case of faulty referral like we often observe. It needs to be ascertained whether the doctor at Kupwara hospital had mentioned in the file of the patient why she was referred to LD and it also needs to be ascertained on what grounds the resident doctor at LD has refused admission to the patient,” said Dr. Khurshid Ahmad Salman, a former top health administrator in Kashmir’s health department.       

Salman said that if the patient delivered the baby outside the hospital without any medical aid, “it means that the patient didn’t need super special assistance for the delivery.” But, he said that the case still needs to be studied in detail for figuring out how and why such negligence occurred and how such incidents can be avoided in future. 

According to him, the patient should have been allowed to stay inside the hospital. “Where has our civility and compassion gone? We know that the doctors at LD and other hospitals do a great job by serving the society, but such incidents spoil all the good work of the doctors and the medical staff,” Salman observed. Referring to the referral system of maternity patients from rural districts to LD, he said that the referral system in the valley is faulty as maternity patients are being referred to the tertiary care hospital even when the patient can be treated at the sub-district or district level. 

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The statistics acquired by Kashmir Observer from the Lal Ded Hospital are reflective of the fact that most of the maternity patients from rural areas, despite the presence of a number of district and sub-district level hospitals in rural districts, are still being referred to LD hospital.  An average 75% in-patients and 70% out-patients from rural districts are treated at Lal Ded Hospital annually, official data of the hospital reveals.   

Overburdening of patients at LD is mostly attributed to poor health services in district hospitals of Kashmir, especially with reference to the health issues faced by women

Majority of the patients who need obstetric care and report the slightest gynaecological problem are referred to LD Srinagar.

“This puts a lot of load on this hospital.” Said Shabir Quarashi, Medical Superintendent of Lal Ded Hospital. “Despite so many district hospitals, which have been established to reduce the burden on this tertiary care hospital, we don’t see any difference.”

“Even the women who suffer from the basic gynaecological problems are referred to this hospital from the district hospitals,” said a senior doctor of the hospital, who spoke on condition of anonymity.  

When contacted, Director Health Services Kashmir, Dr. Kunzes Dolma, said that infrastructure and man-power is not that big a challenge as regards the district and sub-district hospitals. “What is actually needed is coordination among the hospital functionaries at sub-district, district and divisional level. Those who render health services need to be empathetic and should show concern for the patients,” Dolma said. 

“Having said that, we still need to improve upon our infrastructure and human resource though I would still emphasize that empathy and concern for patients is the key,” Dolma said and added that the directorate of health is going to conduct workshops on this and would give a big boost to coordination among hospitals through WhatsApp groups and other communication tools.       

In March 2018, the state health department came up with a report on manpower audit, which paints a gloomy picture of health-care facilities across the state.

“Though funds for raising/upgrading civil infrastructure for both the Health Services & Medical Education sector have been coming under various Centrally Sponsored Schemes and now also under Prime Minister’s Development Plan (PMDP) for J&K, want of commensurate creation of posts of manpower to man these new Institutions has bred a culture of running the new Institutions whether these are New District Hospitals, SDHs/CHCs or PHCs or the Medical Institutions like new Medical Education Institutes like Ayurveda College or GNM/ANM Colleges etc. ‘on internal adjustment basis’ which has led to cannibalization/depletion of the Staff of the existing Public Health Institutions and has harmed both the Old as well as the New Institutions leading to public dissatisfaction and the weakening of the basic Health Care Delivery System,” the report says.

According to the report, which quotes the National Sample Survey 2014 conducted by the union ministry of statistics and program implementation, private health sector provides 72% of the healthcare services in rural areas and about 79% in urban areas in the country. “However, In Jammu and Kashmir, nearly 97% of the healthcare needs of the 14.3 million population of the state are met by public health institutions as the private sector has not developed in the state due to its geographical remoteness, disturbed security scenario and restrictive land laws.” 

The doctor to patient ratio in Jammu and Kashmir, the report says, is amongst the lowest in India. “Compared to the doctor-patient ration of 1:2000 in India, J&K has one allopathic doctor for 3,866 people against WHO (world Health Organization) norm of 01 doctor for 1,000 population,” it says.

The Comptroller and Auditor General (CAG) in it 2017 report had also raised an alarm about the pathetic lack of health infrastructure and human resource in the state’s hospitals. According to the performance audit conducted by the CAG in 84 community health centers (CHCs) and sub-district hospitals (SDHs) of the state, there were only 270 specialist medical officers available in these health facilities against the sanctioned strength of 504 specialists. There was 46% deficiency of specialists in these health centers.

According to the CAG report, the position of staff in blood banks in district hospitals “was worse” as there were only 10 staffers available in these blood banks against the sanctioned strength of 132 posts.

Figures about in-patients and out-patients at Lal Ded Hospital and the percentage of rural patients being treated.  

Source: Government of Jammu & Kashmir   

Overall deficiency of human-resource in Kashmir’s health sector as per Indian Public Health Services (IPHS) Norms 

Source: Health and medical education department, Jammu & Kashmir

Details of prevailing health facilities and deficiency in Jammu & Kashmir 

Source: Health and medical education department, Jammu & Kashmir

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