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Editorial
MARGINALIA | HEALTHCARE : Facts and fiction
By Anuradha Bhasin Jamwal
"
The apologists for the government, some new and some recent converts, have been quick in calling the criticism of health-care award for Jammu and Kashmir at the India Today conclave as some kind of cynicism. Though they fail to offer much empirical evidence in support of their justification for the award that was recently received by chief minister Omar Abdullah with great aplomb for the primary health care in the state, much of the argument is based on the need to de-link primary health care, which is stated to be very good as per the national parameters, from tertiary health care. The latter is already caught in the eye of the storm because of its innumerable shortcomings, primarily the GB Pant children’s hospital fiasco where the matter of extremely high infant mortality rate still remains under scrutiny.

Early this summer when the GB Pant Hospital plight was brought to light by the media, forcing government to finally wake up from deep slumber and look for the usual scapegoats without going into an introspection of why the health department had not even noticed the pitiable conditions and the worrisome infant mortality rates, at the same time reports and surveys also pointed out that overall infant mortality rate in Jammu and Kashmir was far more dismal than the national average. A survey by the Census department had also pointed out that J&K has Infant Mortality Rate of 43 per 1000 children and out of these deaths at least 37 are recorded before a baby attains age of one month. This is a much higher percentage of neonatal death than the national average. The survey also pointed out that the phenomenon is acute in rural J&K where the death rate recorded is 40. In urban J&K the figures are 25. However, at GB Pant Hospital, the only children’s hospital in the Valley, the infant mortality rate was shockingly almost double the national average.

It would be naïve to quote some statistics in isolation to paint a rosy picture of the primary health care in the state and claim that there has been a remarkable improvement in the primary health centres and the dispensaries. All such statistics and claims fall flat in the face of the simple fact that the tertiary health care centres continue to be over-stressed with huge influx of patients and referrals from rural and peripheral areas. The claims also fall flat in the face of the doctors at tertiary health care centres stating that most of the referrals from rural areas and even primary and secondary health care hospitals in the cities reach them in extremely critical stages when it is difficult to save them. Obviously such complicated cases, and if they result in mortality, do not figure in the rolls of the primary and secondary health care centres that failed to provide them the basic health care. The claims, therefore, would be misleading.

Any assessment of the primary health care on the basis of the money that has been dumped in, the renovations and extensions of buildings or the number of appointments would equally be a mirage. You may even find some of the primary health care centres far neater but that would still not indicate that they are performing well. Neither do the achievements like performing one or two odd complicated surgery in such institutions. The grim reality is that complaints keep pouring in of both the primary and secondary health care institutions being short of even the basic wires used for stitching up minor wounds, at any time of the day. Infrastructure continues to be dismal or the infrastructure bought has not been put to use thanks to scarcity of professionals or due to some red-tapism within the hospitals or in the health department. The impressive figure of appointments may still be misleading. There are around 439 ISM (Indian System of Medicines) doctors working in primary health centres, 479 in dispensaries and around 159 ISM doctors working as Assistant Surgeons in various hospitals across Jammu and Kashmir. The government has appointed the doctors possessing degrees in other systems of medicine in rural areas to overcome the staff shortage as doctors holding MBBS degrees refuse to serve there. The appointments were made on the basis of a central government scheme to integrate allopathic health-care with the Ayush dispensaries and hospitals. “Total functional integration between the Ayush dispensaries/hospitals and the health care facilities under the allopathic system is also envisaged so that the entire spectrum of treatments is made available to the public,” the scheme profile maintains. However, the scheme has been implemented with reckless casualness and callousness, aimed at not integrating these different systems of medicine but expecting ISM doctors to perform the jobs they are not qualified to do. 400 posts of doctors and paramedics were recently sanctioned but these have yet to be filled up.

The rosy picture is a mirage. The numbers just don’t add up and raise disturbing questions about the morality of the government that accepts the laurels it does not deserve. It would be wonderful to see the primary health care improve remarkably in Jammu and Kashmir but mere improvement in files of the health department may not lead to improvement on ground. The GB Pant children’s hospital expose earlier this year pointed out to maladies not just within the hospital but also the institutional failure from the top, since the high infant mortality rate, which had been steadily increasing in the past few years, had virtually gone unnoticed by the health department. An institutional denial would only convert such failures into disasters. So, let’s be realistic for a change, not wishful!


News Updated at : Sunday, November 18, 2012
 
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