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 andUnion Territories vis-à-vis health infrastructure, other indicators and goalsachieved.
As per the report the availability of specialists in J&Kdecreased by 3.2% between 2015 and 2018. While in 2015-16, the base year, thepercentage of vacant posts of specialists at district hospital level stood at22.2%, in 2017-18, the reference year, the vacancies grew to 25.4%.
"The lack of manpower in public health facilities is one ofmain reasons of healthcare underutilization," reads the report.
A senior doctor working in J&K Health Department saidshortage of specialists was the main constraint in delivery of healthcare inperipheral and rural set-up.
"This issue has been repeatedly taken up with the governmentas it is a cardinal point in strengthening basic healthcare," he said.
The medico said it was owing to shortage of specialists thatmost of the district hospitals neither had a fully functional andround-the-clock maternity service, nor can they cater to needs of pediatrichealthcare and other needs.
As per Indian Public Health Standards (IPHS), fivespecialists – physician, gynecologist, pediatrician, surgeon and anesthetic –are required at community health center (CHC) level, whereas at districthospital level, the specialists would also include orthopaedic surgeon,ophthalmologist, anaesthetist, ENT specialist and dentist, under MinimumAssured Services.
In addition, under various schemes and programs, specialistssuch as psychiatrist, radiologist and other specialties are also desirable atthe level of district hospitals.
In a bid to reduce the number of referrals from peripheralhealth institutions the State Government has in the recent past talked aboutmany mechanisms, however, owing to scarcity of manpower the high load continuesto burden tertiary care.
"The unjustified referrals are the main cause of dip inhealthcare delivery at tertiary level," a senior healthcare administratorsaid.
At lower levels things seem to have deteriorated too, as perthe report. The number of round-the-clock operational Primary Health Centers(PHC) has decreased during the period under study – 2015 to 2018. While in2015-16 the percentage of 24×7 functional PHCs stood at 45.6%, in 2017-18, suchPHCs fell to 38.4%.
"The 24×7 Primary Health Centres are critical for providingbasic package of health services to the community and for reducing workload athigher level facilities," the report says while underscoring the need tooperationalize more such centers to reduce load at tertiary care level.
But the situation on the ground is contrary to therecommendations. "It is a bitter fact that not even half of the PHCs remainfunctional beyond 4 pm, and in reality, a large chunk of the remaining centersare not functional at all due to death of staff, reflecting upon healthcaredelivery in rural areas," the health official said.
There is however some good news for the state government aswell. The state, as per the report, has stood first in terms ofoperationalisation of first referral units (FRU) in rural setups with a robustinfrastructure and manpower.
The FRU is a sub-divisional hospital or community healthcentre which has the facilities for obstetric surgery, blood transfusion,anaesthesia, specialist pediatric care, operation theatre and requiredequipment.