Pallavi Sareen
Not even one subcentre, Primary Health Centre or Community health centre adheres to Indian Public Health Standards in rural Jammu and Kashmir. Computers and Telephones are a priority for PHCs in rural areas of Jammu and Kashmir despite lack of electricity, water-supply and all-weather roads.
Only 7 PHCs (Primary Health Centres in J&K) have Operation theatre
Ministry of Health and Family’s report on rural health statistics shows that 76% PHCs in rural J&K have computers and 11.4% have telephones. However, out of 526 total PHCs, 98 are functioning without electricity, 125 without regular water supply and 103 don’t have an all-weather motorable approach road.
Videos of pregnant ladies being carried by villagers to reach the nearest healthcare facility is common in rural Jammu and Kashmir. But the fact that more than 60% of these Primary Health Centres are not functional 24X7 and 58% do not have a labour room should have rung alarm bells for J&K’s health department. But the government’s apathy towards the healthcare needs of people in rural J&K is such that only 7 PHCs out of 526, have an operation theatre. The report states that 78.8% PHCs have at least 4 beds, but question arises, what about the other 21.2%? 148 PHCs don’t even have referral transport to facilitate safe movement of a patient to a better healthcare facility.
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How are these Sub-Centres working?
This situation is worst for the sub-centres since the report states that 55.3% subcentres do not have water supply, 40.3% do not have electricity and 22% do not have an all-weather motorable approach road. It is still an improvement from the previous report on Rural Health statistics which showed that 72.6 percent Sub-centres did not have regular water supply, 62.7 were without electricity and 29.3% did not have a motorable access road.
New medical colleges have been sanctioned in J&K to add to the existing healthcare infrastructure and provide efficient healthcare facilities to people living in peripheries of J&K. But despite having adequate number of PHCs, CHCs and subcentres, patients are forced to travel to city since these centres lack basic operational necessities like electricity, water supply, referral transport and road connectivity. The survey has reflected upon the dismal scenario of facilities in peripheral hospitals of J&K.
Community Health Centres fare no better
CHCs are considered the backbone of health infrastructure across India. They were designed to provide referral as well as specialist health care to the rural population. But out of the 84 community health centres (CHCs) functional in J&K, just 45 have living quarters for doctors. Out of these 45, just 25 were inhabited by doctors. Incidentally, just 33 of all the CHCs in J&K had all the four required specialists – physician, gynecologist, pediatrician and surgeon. At least 19 do not even have one functional operation theatre. 28 of these CHCs don’t even have at least 30 beds.
IPHS norms not followed even after 14 years
Indian Public Health standards were laid down in 2007 to ensure quality healthcare service is provided to the citizens of India. Under National Rural Health Mission, it is to be used as the reference point for public health care infrastructure planning and up-gradation in the States and UTs. But according to health ministry’s report, even after 14 years out of 526 PHCs, 84 CHCs and 2900 subcentres, none follow the IPHS standards.
Lack of basic amenities like regular water and electricity; no living quarters, toilets for staff not only pose hurdles for patient care but also to doctors and other staff posted there. It could also be one of the reasons why many doctors who are posted in these peripheral areas never end up joining duty or regularly working in these peripheral hospitals. After all, how will an X-ray machine work without electricity? How will a gynaecologist help a pregnant lady in labour without a labour room? And how will a surgeon perform even a minor surgery without an Operation theatre?
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Whose fault is it?
Since health is a state subject, ideally these infrastructural lapses were to be addressed by the state government. Central government also provides support to various States/UTs under various centrally sponsored programmes and schemes to improve infrastructure and facilities, along with manpower in healthcare institutions, with focus on rural areas.
Recently, Union Health Minister Dr Harsh Vardhan, responding to queries in Rajya Sabha stated that under the National Health Mission (NHM) financial and technical support is provided to States/UTs to strengthen their healthcare systems including for expansion of Public health institutions such as District Hospitals, Community Health Centres (CHCs), Primary Health Centres (PHCs) and Sub-health Centres (SHCs) as well as for deployment of human resources to cater to Public health services for all.
Administration’s response
Director Health Services Jammu Dr Renu Sharma refused to respond to calls as well as email. Director Health Services Kashmir Dr Sameer Mattoo said, “In February 2018, the Government of India announced that Health & Wellness Centres (HWCs) would be created by transforming existing Sub Health Centres and Primary Health Centres to deliver Comprehensive Primary Health Care.”
He mentioned that the transformation of existing PHC’s and SC’s into HWC’s has already begun in a phased manner. “Uptil now 673 PHCs & SCs from the set target of 921 have been made into operational HWCs and rest will be operationalized in the upcoming year,” he said.
Key Points of AB- Health & Wellness Centres
As mentioned by Director Health Services Kashmir, the key points include: a) Infrastructure & Facade Branding was approved for 7.00 lacs for a HWC-Sub Centre & 4.00 lacs for HWC’s –PHC
b) For Procurement of necessary equipments 1.00 lac has been approved for each AB-HWC.
c) And up till now Expenditure of 1122.51 lacs on Infrastructure upgradation & Facade Branding and 345.9 lacs on procurement of equipments have already been done for the operationalised 673 HWC’s.
d) Availability of Medical Officers at HWCs- PHC’s.
e) Availability of two MPW in all HWC’s-Sub Centres
f) Availability of staff nurses.
g) Availability of Lab Assistants and Pharmacists at HWCs- PHC
h) Biometrics attendance system at every HWCs-PHC/SC
i) At these HWCs free drugs & diagnostics are also provided. Each AB-HWC-Sub centre will have 23 free drugs & 6 basic diagnostics facility and AB-HWC-PHC will have 71 drugs & 17 diagnostics services made available under free drugs & diagnostics policy from the Government of India.
j) Screening for common NCDs is also available in these HWCs-PHC’s/SC’s.
k) Availability of separate toilets for males & females. l) Availability of Electricity. m) Availability of Water supply. After achieving all these parameters a Health & Wellness Centre is considered to be operational.
