Shortage of specialists in peripheries burdens J&K's tertiary healthcare: NITI Aayog

Shortage of specialists and non-availability of round-the-clock services in peripheral hospitals continues to burden J&K’s tertiary health care system, with ‘unjustified’ referrals, states an official report.

The recently released ‘Healthy States Progressive India’ report by NITI Aayog profiles the progress made by states including J&K and Union Territories vis-à-vis health infrastructure, other indicators and goals achieved.

As per the report the availability of specialists in J&K decreased by 3.2% between 2015 and 2018. While in 2015-16, the base year, the percentage of vacant posts of specialists at district hospital level stood at 22.2%, in 2017-18, the reference year, the vacancies grew to 25.4%.

“The lack of manpower in public health facilities is one of main reasons of healthcare underutilization,” reads the report.

A senior doctor working in J&K Health Department said shortage of specialists was the main constraint in delivery of healthcare in peripheral and rural set-up.

“This issue has been repeatedly taken up with the government as it is a cardinal point in strengthening basic healthcare,” he said.

The medico said it was owing to shortage of specialists that most of the district hospitals neither had a fully functional and round-the-clock maternity service, nor can they cater to needs of pediatric healthcare and other needs.

As per Indian Public Health Standards (IPHS), five specialists – physician, gynecologist, pediatrician, surgeon and anesthetic – are required at community health center (CHC) level, whereas at district hospital level, the specialists would also include orthopaedic surgeon, ophthalmologist, anaesthetist, ENT specialist and dentist, under Minimum Assured Services.

In addition, under various schemes and programs, specialists such as psychiatrist, radiologist and other specialties are also desirable at the level of district hospitals.

In a bid to reduce the number of referrals from peripheral health institutions the State Government has in the recent past talked about many mechanisms, however, owing to scarcity of manpower the high load continues to burden tertiary care.

“The unjustified referrals are the main cause of dip in healthcare delivery at tertiary level,” a senior healthcare administrator said.

At lower levels things seem to have deteriorated too, as per the report. The number of round-the-clock operational Primary Health Centers (PHC) has decreased during the period under study – 2015 to 2018. While in 2015-16 the percentage of 24×7 functional PHCs stood at 45.6%, in 2017-18, such PHCs fell to 38.4%.

“The 24×7 Primary Health Centres are critical for providing basic package of health services to the community and for reducing workload at higher level facilities,” the report says while underscoring the need to operationalize more such centers to reduce load at tertiary care level.

But the situation on the ground is contrary to the recommendations. “It is a bitter fact that not even half of the PHCs remain functional beyond 4 pm, and in reality, a large chunk of the remaining centers are not functional at all due to death of staff, reflecting upon healthcare delivery in rural areas,” the health official said.

There is however some good news for the state government as well. The state, as per the report, has stood first in terms of operationalisation of first referral units (FRU) in rural setups with a robust infrastructure and manpower.

The FRU is a sub-divisional hospital or community health centre which has the facilities for obstetric surgery, blood transfusion, anaesthesia, specialist pediatric care, operation theatre and required equipment.