J&K: A leader in health indicators is falling back

Dr. Ramani Atkuri

It is now more than a year since the State of Jammu & Kashmir saw the end of its special status under Article 370. This radical change was brought about suddenly, after the State was put on lockdown with a disruption of all modes of communication. It was done with the stated objective of integrating J&K with the rest of India, to bring in development, and improve the security situation.

We examine below how one year of this change in Statehood has affected healthcare in Jammu and Kashmir.

Jammu and Kashmir was already much better developed than a host of other States with regard to many health indicators. A few examples of maternal and child health indicators are shown below, using data taken from the fourth National Family Health Survey. We have compared it with all-India figures, as well as with those of Uttar Pradesh which is considered poorly developed, and with Gujarat which has been considered a model of development by many.

 

Indicator

Jammu and Kashmir

Uttar Pradesh

Gujarat

All-India

Malnutrition among children under 5 (wasting)

16.6%

39.5%

39.3%

35.8%

Infant mortality (per 1000 live births)

32

64

32

41

Women malnourished (BMI <18.5)

12.1%

25.3%

27.2%

22.9%

Current use of family planning methods

57.3%

45.5%

46.9%

53.5%

Mothers who had four antenatal care visits

81.4%

26.4%

70.5%

51.2%

 

Institutional childbirths

85.6%

67.8%

88.5%

78.9%

Full immunisation among children

75.1%

51.1%

50.4%

62%

Women who experienced spousal violence

9.4%

36.7%

20.1%

31.1%

 

Going by the above indicators, Jammu and Kashmir was doing better than the national average in most reproductive and child health matters.

Current status

The Union Territory of Jammu and Kashmir has a lockdown-within-a-lockdown situation due to the present Covid-19 pandemic. After seven months of no internet access, a low speed (2G) internet access has been allowed. Between mid-January 2020 and August 4, 2020, Amnesty International documented 67 internet shutdowns. In May 2020, for instance, telephone, mobile and internet services (except some services by one service provider) were blocked four times for security reasons. The impact was immediate.

The snapping of communication links meant that doctors had to turn away seriously ill patients who required emergency surgery, because operation theatre staff could not be contacted.

As of May 7, Jammu and Kashmir had a total of 793 cases of Covid-19, and nine deaths. Yet the entire Kashmir valley as well as three districts of Jammu were declared a “red zone”, areas under the gravest threat, and with the maximum restrictions. The snapping of communication links meant that doctors had to turn away seriously ill patients who required emergency surgery, because operation theatre staff could not be contacted. Several instances have come to light, like an elderly man with aortic regurgitation who complained of chest pain but could not consult a doctor since none of them had phones which were working. Difficulties in communicating with family members increased the stress that people were already undergoing.

A report quoted a gynaecologist working in Kashmir for decades as saying that long years of conflict had already affected women there, and the situation worsened after last year’s clampdown, with increasing numbers of women with acute depression in pregnancy, infertility and sexual dysfunction. Women were unable to reach even nearby health facilities for care.  Women have again been the major sufferers in the current lockdown due to the Covid-19 pandemic – while around 500 women tested positive for coronavirus infection, a few died due to alleged medical negligence in hospitals, and others due to inability to access proper care and treatment.

The non-availability of high-speed internet prevents people from accessing required information about the infection in order to adequately inform and protect themselves.

One year after the changed status of Jammu and Kashmir, the Covid-19 pandemic adds a new challenge to the already difficult situation in the State.  The non-availability of high-speed internet prevents people from accessing required information about the infection in order to adequately inform and protect themselves. Anxiety about the disease can be reduced by access to facts from reliable sources. According to Amnesty International in its report the people of Jammu and Kashmir are entitled to remain informed of the threat to their health, and the right to access this information in local languages and through media that are easily understood. For this, access to high speed internet is essential. Even doctors are unable to access the latest information and developments on Covid-19 situation and management due to the slow speed of the internet.

Children living in Kashmir witness violence and killings on a regular basis, and several have been injured or killed in cross-fire. Children who have suffered pellet-gun injuries in their eyes and have partially or fully lost vision have been forced to drop out of school and stay at home. Often the traumatic experience has resulted in their becoming depressed or aggressive.

A doctor working in Srinagar says that he has seen a doubling of the proportion of patients with psychogenic causes of chronic pelvic pain between 2018 and now.

A doctor working in Srinagar says that he has seen a doubling of the proportion of patients with psychogenic causes of chronic pelvic pain between 2018 and now. In addition to the restrictions in place due to the lockdown across the Kashmir valley, the current Covid-19 pandemic has also kept non-Covid patients away from hospitals, with patients often arriving in extremis, when it is difficult to save them. Like in other places, non-Covid and non-emergency surgical care is suffering, with some patients choosing to go to private hospitals and clinics which are not managing Covid-19 patients. The economic impact of the lockdown over the past year has been severe, and many patients are deferring treatment due to the costs involved. Though the Government health insurance scheme called Ayushman Bharat (which is online) is functioning, it is very slow and involves long waiting times.

There is an urgent need to allocate enough funds, lift communication restrictions and involve citizens in a sensitive manner to improve access and quality of healthcare in Kashmir.

When J & K enjoyed a special status, there were separate budgetary allocations under the Union Health Budget for the State. Since last year, that budget head has been removed. Whether this has been adequately compensated for by financial allocations through another mechanism is not clear.

In view of the high levels of stress, poor access to services and inadequate infrastructure, there is an urgent need to allocate enough funds, lift communication restrictions and involve citizens in a sensitive manner to improve access and quality of healthcare in Kashmir. Otherwise, the health status of the population, which as we mentioned earlier, was much ahead of most other States in India, may worsen and be reduced to the national average.

(Dr. Ramani Atkuri works with tribal and rural communities in Central India, with special interests in communicable diseases, women's health, hunger and malnutrition)