Over the past several years, the Health and Medical Education Department has been at the tenterhooks to push healthcare and medical education in Jammu and Kashmir. Administrative Secretary, H&ME Department, Bhupinder Kumar, who has served in many positions in J&K, in an exclusive interview with Rising Kashmir’s Senior Health Correspondent, M Peerzada, talks about the ongoing and upcoming projects in J&K’s health sector that are aimed to further boost the healthcare delivery and medical education.
Excerpts!
In Dec 2021, J&K Administration Council (AC) approved establishment of two medi-cities, one each in Kashmir and the Jammu division. What has been done so far?
Medi-cities are being developed at Miran Sahib in Jammu and Sempora, Pampore in Kashmir as per the new Industrial and Land Allotment Policy, for which land in the industrial estates has been earmarked/allotted by the Industries & Commerce Department. A total of 22 applications have been received for setting up different health facilities and Industries Department has issued LOA to the interested vendors. Industries and Commerce Department is the Nodal Department.
When should we expect completion of AIIMS Awantipora? Till date, some 30 percent work has been completed? What is its status?
Initially, the project of AIIMS Awantipora was delayed due to some security concerns for which the master plan was revised which resulted in shifting and redesigning of various buildings. Matter regarding additional 34 acres of land for the project has also been resolved and Rs 94.16 cr stands released for the purpose which is being disbursed by the Collector Land Acquisition Awantipora. The project is going on smoothly and targeted for completion by Dec 31, 2024.
The rampant practice of unnecessary referrals is a major issue especially in tertiary care hospitals. Are our rural hospitals underperforming?
Broadly, the referrals have been streamlined as the regular referrals audits are being carried out to avoid unnecessary referrals. Reports of referrals are being shared with the Administrative Department. Mainly the referrals of patients happen because of the non-availability of some specialist/facilities in the rural setup which are difficult to create and maintain. The department is in process for setting up of CTs up to the level of district and MRIs to the level of all New GMCs with reporting through Tele-radiology, to reduce the load of the tertiary care hospitals.
Rural Health Statistics (RHS) 2020-21 has revealed shortage of 577 doctors in JK. What is being to fill these posts?
J&K has established five New GMCs at Anantnag, Baramulla, Rajouri, Doda and Kathua and two more are being established at Udhampur and Handwara, thus increasing the number of MBBS seats from existing 500 to 1100. With the operationalization of Udhampur and Handwara GMCs, it will become 1300. In next two years, first batch of MBBS students will be passing out, the shortage of doctors in the rural areas will start to decrease.
As per the RHS, paramedical posts are also vacant at PHCs in J&K. What is being done?
J&K is in the process of establishing 15 B.Sc Nursing Colleges and has also started B.Sc paramedical courses in all the medical colleges. A total of 440 B.Sc nursing seats and 590 B.Sc Paramedics seats have been added in the last couple of years. Notably, 90 more nursing seats are being added by operationalization of B.Sc Nursing courses in Nursing College Rajouri and Pulwama. There are 08 Nursing Colleges functional, 02 Nursing College viz. Pulwama and Rajouri will also get operationalised shortly, whereas the 05 Nursing Colleges viz. Budgam, Kathua, Shopian, Kulgam & Baramulla (PMDP) would also be start operationalized.
In 2019, Directorate of Health Services Kashmir (DHSK) submitted first of its kind health policy draft to H&ME Dept. Is there any progress on that?
Broadly, the recommendations of all the HODs are taken into account while framing any policy. As of now, the department is focusing on achievement of Sustainable Development Goals and the targets set out by the Government of India received through the outcome of the recent Chief Secretaries’ Conference held at Delhi. Key areas inter-alia includes Mother and Child Health, Communicable & Non-Communicable Diseases, Illness to Wellness, Family Planning & Immunization, digital initiatives in health care and provisioning and optimization of Human Resource.
DNB seats have increased to 250, how will it improve healthcare?
J&K model of implementation for DNB has been appreciated as best practices in the recently held Chief Secretaries Conference at Delhi. More than 250 seats have been brought under the ambit in the last couple of years and it is envisaged to take the total number of DNB seats to 400. J&K has distinction of being first movers in starting DNB courses at CHC level. The initiative will improve the health sector and will help to get rid of the problems of shortage of specialities in the rural areas, thus increasing the availability of specialized care at the level of the Secondary care level institutions.
Specialized care will become more affordable and accessible in almost all the Districts. Efforts are afoot to further take the initiative to the level of CHCs, which will help in reducing referrals/burden to tertiary care to strengthen rural healthcare delivery system. More facilities and disciplines are also targeted ensuring both vertical and horizontal expansion. The 50 percent of DNB seats are being offered to the in-service candidates, thus prompting the local talent in providing the patient care as well their career promotion.
What is being done to strengthen rural hospitals?
J&K has a robust infrastructure and more than 4100 health facilities are available, which broadly caters the geographical extent as per the IPHS norms as far as coverage is concerned. Gap analyses have been completed and it is envisaged to provide the necessary strengthening in terms of manpower, equipment and supplies in a phased manner. Primary healthcare is being improved through establishment and operationalization of Health & Wellness Centres in sub-centers, PHC & NTPHC. Against, the target of 2700, more than 3000 facilities have been operationalized which will improve drug and diagnostic facilities at the primary level.
There is also shortage of nurses across hospitals. Do you have any plans to add it?
Manpower enhancement is a regular process. Efforts are being made to fill the post created for the purpose as well as adding New Nursing colleges, would help when the pass-out become available.
Amid growing concern of spurious drugs, many hospitals lack quality control laboratories and there is no in-house check on drugs supplied to them putting patients at risk. What are the plans?
Govt. of J&K has adopted Drug Policy in 2012 to streamline procurement of quality medicines. Controller Drugs J&K monitor the quality of drugs as per the provisions of the Drugs & Cosmetics Act, 1940 and rules framed there under. Strict enforcement is done by taking appropriate action against the erring manufacturing units/whole sellers/retailers. Around 1 percent of the drugs sold/manufactured/imported in the country are tested in government-run drug testing laboratories pan India. Besides, the drugs procured through J&KMSCL, Central procurement of H&ME Dept. in J&K are tested for every batch for its quality, purity and strength before its distribution to the public health facility. Moreover, drug samples are also sent to notified drug testing laboratories.
What measures need to be taken for quality patient care?
The UT has robust public health infrastructure with more than 4100 health facilities at various levels which is being regularly strengthened by way of providing machinery equipment and manpower. In recent years, over 2100 seats in medical education were added for improving quality of healthcare. All vacant posts have been referred to selection agencies for recruitment.
A fleet of more than 200 Advanced Ambulances under 108/102 Ambulatory services are helping the cause of patient care as the response time has also been very quick. Digital is the way forward. The introduction of digital initiatives like Mera Aspatal, HMIS and ABDM, e- Sanjeevani, Tele- MANAS are also helpful in improving quality of healthcare.
There are six trauma hospitals but these haven’t been upgraded. These lack ICUs, theaters, infrastructure and manpower. Do you have any plan to strengthen them?
Trauma facilities needs to be strengthened especially in terms of manpower as neurosurgeons, orthopaedics, anaesthetists are the backbone of a trauma hospital. There is dearth of such specialists in our UT. Every effort is being made to engage such manpower. That’s why the digital medium of Tele medicine, tele-consultancy and Teleradiology besides advanced ambulatory services are of paramount importance in dealing with trauma case.
New hospitals are coming up besides district hospitals strengthening initiatives holistically would help a better trauma care. The existing trauma centres shall also be strengthened in terms of necessary requirement, still the challenge remains on part of manpower to operate upon such equipment.
Where you see J&K’s healthcare in next five years? What major projects are being planned for future?
The department has formulated a roadmap and is working on it to achieve all the desired goals contained in its vision and mission in line with Sustainable Development Goals. World-class health infrastructure with around 350 Health Projects/works worth more than Rs 7000 cr are coming up in J&K which includes prestigious projects like two AIIMS, 09 GMCs, 15 Nursing Colleges, two SCIs, two B&J hospitals etc.
In the coming five years, J&K would be having a world-class infrastructure besides full coverage of health facilities with geographical presence across UT coupled with Universal Health Insurance Cover for entire population and Technical Interventions through ABDM, Tele MANAS, e- Sanjeevani etc. will be a game changer in health sector.
What will be the major focus of health department this year?
The department is in pursuit of achieving accessible, quality health services. For this the department is targeting national quality certification such as NQAS, Laqshya, NABH, NABL and Kayakalap.
What measures are being taken to limit NCDs in JK?
We have started the population-based screening of all people above 30 for early detection and extensive IEC regarding healthy lifestyle. We are assessing risk factors of NCDs in healthy population through community-based assessment checklist and those with risk factors referred to doctors. We are ensuring adherence to treatment of hypertension and regular supply of medicine through India Hypertension Control Initiative and regular follow up and treatment of patients detected with NCDs.
National programs such as Comprehensive Primary Health Care (CPHC), National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), National Mental Health Program, National Tobacco Control Program and Prime Minister National Dialysis Program (PMNDP) under NHM are already specifically targeting prevention, screening, control and treatment of NCDs.
