Azkhar Ahmed Fami
Of the several questions that should bother each one of us regarding the health care services in our country, the most crucial one that we must ask ourselves is – should there be a moral obligation to make healthcare accessible to everyone as needed or it should be treated as a commodity and subjected to similar marketplace influences? In our country, where a large number of people are living a life of abject poverty and under unsafe conditions with poor access to health and hygiene services, answer to this one question will decide the road ahead.
India is among the countries with the least public health spending. Between 2009-10 and 2018-19, public health expenditure as a percentage of GDP increased by only 0.16 percentage points from 1.12% to 1.28% of GDP. It remains a far cry from the 2.5% GDP health spend that has been the target for quite some time now. These statistics, in reality, represent lives of several “unfortunate” communities who are living a helpless life as far as healthcare is concerned.
In border district of Poonch, approximately 250 kilometers from Jammu in the newly announced Union Territory of Jammu and Kashmir, several communities residing in the most difficult to access areas do not have access to even basic health care facilities. Several such villages are devoid of any health centres and if there is one, its effectiveness is marred due to many concerns such as shortage or unavailability of staff, insufficient medicines, and infrastructure problems. For a medicine as basic as a paracetamol, villagers have to walk 4 kilometers up and down the hilly trail.
Gani is a nondescript village tucked away in the mountains on the border. Due to cross-border conflict, shelling and firing during ceasefire violations is not uncommon. Caught in between the fire are the innocent villagers. The uncertainty is such that no one is sure of what will happen the very next moment. Many lives are lost on the spot while some, who get injured due to cross-border firing, die due to lack of healthcare services in the area.
Thirty-year-old Ghulam Nabi, a resident of Gani village, while sharing a horrific experience said that “When my daughterfell while playing and was severely injured, I couldn’t reach hospital on time or find a doctor to treat her. I had to walk8kilometers to Primary Health Centre (PHC) in Mankot for treatment as I couldn’t afford a vehicle.” Nabi works as a laborer to sustain his family that consists of his wife and two children. He barely manages to make their ends meet.
The head of the same village, Muhammad Khadim, a teacher at a private schoolsaid, “If someone gets injured during the cross-border firing, how can we get them to the hospital? That time we try to stay inside and not become a victim ourselves.”
While informing about the impact of poor health infrastructure in the region, 45-year-old Rehman Master from Gani village narrated a rather unfortunate incident. Resident of the same village, 28-year-old Tahira Kausar was riding pillion on a motorbike when she met with an accident. “Injured severely on head, she was taken to the nearby Sub-District hospital in Mendhar block where the doctors referred her to the district hospital in Poonch which was approximately 50 kilometers. Due to unavailability of certain facilities, doctors here referred her to Rajouri district which is again around 90 kilometers from Poonch town. On her way to Rajouri, Tahira lost her life,” shared Rahim expressing remorse over the unfortunate incident that took Tahira away from her two innocent sons.
As per villagers, request for a local medical dispensary has been raised several times with the concerned authorities but no action has been taken so far. Even in the “Back to Village” programme, an initiative of the Government of Jammu and Kashmir to reach out to the people at the grassroots level, the concerns were raised but to no avail. The Covid-19 pandemic has further exposed the lack of a basic health infrastructure in the region. Here, reside families who have to work hard to arrange for a day’s meal. How are they expected to arrange for travel, doctor’s fees and medicines?
“As per healthcare schemes, medicines are available free of cost in government hospitals, but this isn’t true for our district. There have been incidences where doctors have allegedly exploited the poor villagers by demanding fee or by not providing medicines at the subsidized rates as directed by government,” shared Muhammad Irfan (name changed), a resident of the same village.
“What a difficult time it is for a poor person to fall sick. Wehave to fight for treatment and for the medicine too” added Irfan.
As per the Block Medical Officer, Mendhar, Dr Pervaiz Ahmad Khan, under the National Health Mission (NHM), PHCs are established to cover a population of 30,000 in rural areas and 20,000 in hilly, tribal and desert areas. The population of Gani village is approximately 1000 and is covered by the PHC in Mankot. “Considering that this is a border village, we have constituted a team of doctors trained to provide emergency first aid services in case of cross border firing or shelling,” he informed.
Health should now be considered a basic human right. As per a report published in Down to Earth based on National Health Profile (NHP) 2018, insufficient allocation for the health sector pushes 7% of Indians below the poverty line and about 23% of the sick can’t afford healthcare.
Recently, the Prime Minister launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) Social Endeavour for Health and Telemedicine (SEHAT) scheme via videoconferencing to extend health insurance coverage in J&K. As part of the initiative, free of cost insurance cover of up to Rs 5 lakh will be provided to all the residents of J&K. To ensure that residents of the border villages are able to benefit from the insurance scheme, health care infrastructure should be strengthened in and around these border villages.
Azkhar Ahmed Fami