Dr Vivek Sharma
Health as a component of life has remained immensely significant through the ages. The mighty forces of ‘Alexander the Great’ refused to move forwards from north western India on account of physical and mental exhaustion (though they also feared the presence of a strong force on the other side of Ganges). They found it difficult to ignore a healthy body and mind. We have another instance where health was severely impacted. The Spanish influenza of early 20th century consumed millions of lives. Almost a hundred years later an unknown ailment spread like a wild fire and crippled most of the world. It turned out to be COVID-19.
These events reflect the prime importance of health in our lives for which the Govts across the world make interventions to deal with its preventive and promotive aspects. Likewise, the Govt of India has made rapid strides to address health holistically through measure like Ayushman Bharat, Janani Shishu Suraksha Yojana, Universal immunisation programme to name a few. And if we talk about Union Territory of Jammu and Kashmir, this part of the world could not remain untouched by the changing health care needs and the aspirations of its people. For the past few years, it has been on the path of rapid progress to achieve SDG3(Sustainable Development Goal 3) i.e, Good health and well being for all.
Defining health: According to WHO, “Health is a state of complete physical, mental and social well being and not merely the absence of a disease or infirmity.”
It’s multidimensional aspect , therefore, makes it holistic.
Let’s see how the health scenario of Jammu and Kashmir has transformed.
Rs 7,177 crore have been invested in the health care infrastructure development projects in J&K.The establishment of 7 new medical colleges has taken the total count to 11 with two AIIMS – one at Vijay Pur,Samba and other at Awantipora,Pulwama. In addition to it, 2 state cancer institutes, 2 Bone and joint hospital and 2 mental health institutes have also been established. In terms of Primary and secondary care, District hospitals (DHs),Community health centres (CHCs), Primary health centres (PHCs) and sub centres are being reformed with capacity and infrastructure. Nursing colleges are also mushrooming in the UT to provide quality health care workers. The Unani and Ayurveda colleges add strength to the health system. Integration of Allopathy and AYUSH has made it holistic.
On the other hand, there is a significant increase in workforce through regular recruitment by JKPSC and NHM. Assitant professors are being recruited in GMCs. Over the last 5-6 years,the Post graduate seats have also increased. PGs are now made available to work at District hospitals under District Residency programme (DRP). It has added to the quality of health care by providing specialist service. Medical officers have been regularly recruited by JKPSC over the last 4-5 years to promote primary and secondary care. A new cadre of Heath workers, a Community Health Officer (CHO) or a Mid level Health Provider (MLPH), is also being introduced at SHC-HWC to improve community outreach and continuum of care. The presence of a network of about 13500 ASHA(Accredited Social Health Activist) workers has helped to connect the community to primary health service. The ASHA workers were recently acclaimed by WHO for their outstanding contribution towards protection and promotion of health.
The amount and quality of work has improved across all levels. New and advanced procedures are being done. DHs andCHCs have seen a remarkable shift resulting in improved quality of care and reduction in referral rates. Evening OPD of consultants started at Govt. Hospital Gandhi Nagar on 18-01-22.Total knee replacement and hip replacement surgeries are being performed at GMC Udhampur. First ever in the history of India that an advanced Laproscopic trans abdominal Pre peritoneal(TAPP) inguinal hernia surgery and Laproscopic Ovarian Cystectomy were performed at the level of a CHC at CHC Katra. Some experts claim it to be the first in the world at the level of a CHC. Govt. Hospital Gandhi Nagar is the first District hospital in North India to have a registered medical centre for palliative care under CTC3 programme.
Initiatives:
Ayushman Bharat has been a promising intervention of the decade. AB-PMJAY SEHAT provides universal health insurance in UT of J&K which is otherwise applicable to only poor and marginalised families in the other parts. It has made health care affordable with an annual coverage of 5 lakh rupees per family. Golden card has made lengthy hospital stays and costly procedures affordable at Govt facilities. Ayushman Bharat’s 4 components AB-HWC (Ayushman Bharat Health and Wellness Centre), AB PMJAY SEHAT, ABIM (Ayushman Bharat infrastructure Mission ), ABDM (Ayushman Bharat Digital Mission) have the capacity to take the health care to new heights. The long wait for OPD registration is reduced with the introduction of Scan and Share Queue Management System under ABDM by using ABHA ID. Under ABDM, the UT is on an uphill task of digitising the health records of individuals and linking them with ABHA ID and Health professional registry (HPR).
* Model emergency rooms have been set up at DH, SDH and PHC levels under ‘Save life Jammu’ initiative. These emergency rooms are equipped with modern machinery and emergency drugs.
* For referrals 102 and 108 ambulance services are available.
* To meet additional medical oxygen requirement in the prevailing COVID 19, the Govt. of J&K has started the installation of oxygen generation plants in 37 COVID dedicated health institutions at a cost of 223.80 crore under Budget 2020-21.
* Under the District Residency Programme(DRP), the Post Graduate students are required to undergo 3 months of mandatory postings at District hospitals resulting in improved services at DHs.
* Initiation of weekly awards to the best health employees.
* ‘Kayakalp awards’ are conferred upon those health facilities which have achieved higher levels of cleanliness, hygiene and infection control.
* Yoga day is celebrated every year on 21st June to promote physical and mental health.
With all these interventions the UT is heading towards higher levels of health. This can be understood from following facts-
J&Ks neonatal mortality rate(NMR)is 9.8 per 1000 live births against national average of 24.9.
Infant mortality rate (IMR) has reached 16.3
Under 5 mortality rate is 18.5
Sex ratio at birth increased from 923 to 976.
Institutional births have increased to 92.4 from 85.5%
80.9% mothers have 4 antenatal visits as compared to national average of 58.1%.
J&K has achieved 100% vaccination coverage for COVID19 for the age groups of 18 and above.
The above initiatives, indicators and outcomes give credence to the fact that the winds of change have arrived in the UT of J&K and it is on the path of rapid progress over the past few years. Now, it is the time to improve upon our shortcomings and make it a world class health care. Issues like shortage of staff in newly established medical colleges, equipments, health care awareness of people, mental health and sensitivity towards the patient are some of the areas that can be improved. Health is a basic building block not only for an individual but also for a family, society and a nation. No community or nation can excel, if there is a poor and inaccessible health care system. Western world has progressed on the back of a sound education and an advanced health care system. Therefore, our endeavour should be towards capitalising on our progress and improving upon our shortcomings to achieve higher standards of heath thereby turning it into a remarkable global case study of 21st century.
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