In J&K, nearly 97 percent of healthcare needs (OPD/IPD services) are met by public health institutes, reveals a latest report on manpower audit in health department, underlying importance of government healthcare system in the state. In 2017-18 at least 2.39 crore OPD visits of patients were recorded in J&K and out of them 99.2 percent (2.22 crore patients) were seen only in government hospitals. The private sector accounted for a minuscule 0.8 percent of all OPD visits, as per the report. Besides, 96.6 percent (8.36 lakh) patients who needed admission availed public health facility while 91.3 percent of all deliveries took place in government hospitals. Given the dependence on public healthcare sector and ever growing rush of patients, are policies and plans to equip state health institutes adequate to cater to the demands. At present there are 22 district hospitals (DH), 88 sub-district hospitals (SDH), 406 primary health centers (PHC), 2847 sub-centers, two Indian system of medicine (ISM) hospitals, 470 old ISM dispensaries and 87 new ISM dispensaries operating in state. Five of these 22 DHs were created in 2007, when new districts were carved out – two of them in Jammu (Reasi and Samba districts) and three in Kashmir (Bandipora, Ganderbal and Shopian districts). But these district hospitals have still manpower sanctioned for sub-district hospitals, the report reads. "What actually changed on the ground for these hospitals is just the name. In terms of manpower and facilities these facilities continue to be of the level of sub-district hospitals," reads the report. In addition, in past 15 years, five new SDHs were converted to maternity hospitals – Safakadal Idgah, Watlar, Gulab Bagh, Khanmoh Pandrethan and Wayil. During this period, 11 PHCs were upgraded to SDHs – seven of them in Kashmir – while seven new PHCs were also established. The up gradation of hospitals and creation of new ones meant government was required to create additional posts. To meet this demand 140 new positions of assistant surgeons were approved to cater to demand. But the move met a road block when finance department refused to clear 134 of these 140 new posts. For past more than a decade these posts have been kept in abeyance, which has defeated the purpose of setting up new health centers and upgrading the existing ones, said the official. The health department report has acknowledged it, saying functioning of these new health institutions was "totally erratic and unsatisfactory for want of adequate staff". This ill planning has continued over the years. In 2014, at least 371 sub-centers were upgraded to level of new type primary health centers (NTPHC). In total, 641 NTPHCs have been announced over past one-and-a-half decade. But a majority of them are yet to become operational owing to shortage of manpower. There are a total of 605 sanctioned positions of doctors for these PHCs. However, only 62 of these positions have been filled leaving 543 positions (90 percent) vacant. Out of 826 approved new sub-centers for different districts across J&K, only 640 have been set up "partially" till date by engaging one auxillary midwife (ANM) nurse per center under National Health Mission (NHM). However, as per the norms, the essential staff for sub-centre includes one female ANM and one male and one Safai-Karamchari. As a result of growing shortage of manpower at different levels, health sector is left with no option but to burden existing human resource to run new health institutions. The scenario has been described as "cannibalization" of health sector by health and medical education department, in one of its reports. The candid admission made in the manpower audit report that the staff depletion has "harmed both the old as well as the new institutions, leading to public dissatisfaction and weakening of the basic healthcare delivery system" sums up the scenario in public healthcare sector. Today, while there are hospitals and other health institutions set up in every corner of the state, most of these are not operational round-the-clock. The situation is even worse in far off areas. In Gurez, though infrastructure is in place, inadequate manpower is taking toll on healthcare delivery and recently district commissioner Bandipora took to social media to invite doctors to work in Gurez. In Kupwara, located right in middle of the town, the district hospital, has no pediatrician. People from Machil, Tangdhar and Lolab are forced to take their sick children to Srinagar. To add to the woes of rural masses in J&K, lack of adherence to rules while posting and transfer of doctors results in even scantier availability of staff in remote areas. Recently 65 doctors found on unauthorized absence for long time were struck off rolls to pave way for fresh recruitments to serve in their positions. An official said the department has approached finance department to seek concurrence to various positions required at different levels in health sector. While recruitment in the sector has been moving at snail's pace, this year, J&K Public Service Commission recruited 371 medical officers to make the PHCs functional. However, a major portion of this manpower slipped out of hands of the department owing to loopholes in recruitment system. There is no denying that the department is working beyond its limits to deliver healthcare, but "it needs to keep improving to be able to continue healthcare delivery, which can happen only if the manpower constraints of the department are addressed in right earnest" highlights the report. A senior administrator while talking about the prevailing situation in state health sector said as per National Sample Survey-2014, conducted by ministry of statistics and program implementation, private health sector provides 72 percent of healthcare services in rural areas and about 79 percent in urban areas across in India. "In our state their (private health sector) contribution is minimal (0.8 percent) which in turn should make planners realise importance of public health sector and need to overcome shortcomings," the official concluded.