Opinion | Healthcare Infrastructure: Connecting the Urban-Rural Divide

Every doctor assigned to work at a rural primary health center in Kupwara and Kishtwar would inevitably find themselves talking about the same issue: loneliness. As per the Health Dynamics of India 2023-24 report by the Ministry of Health and Family Welfare, out of 1,517 sanctioned posts of doctors/medical officers in rural primary health centers in Jammu and Kashmir, 935 posts are filled while 582 are left vacant. For an area where distance itself poses a challenge, the problem is just another hurdle among many others.

The gap between Kashmir division and Jammu division creates an additional dimension of the issue. The population of Kashmir was estimated to be 8.56 million in 2025, while that of Jammu province was 6.34 million; however, while Jammu division has 19 consultant radiologists, Kashmir only has nine and Kashmir does not have any Senior Consultant radiology positions at all. Doctors Association Kashmir had been reporting critical shortages of consultants and senior consultants in various specializations, such as radiology, anaesthesia, dermatology and psychiatry, and 23 senior consultant positions were still vacant in the territory. The doctor-to-patient ratio in Jammu and Kashmir was one to 1,800 by 2025, according to the evaluations of the health care sector, which is far from the recommended ratio by WHO of one to 1,000 and Indian national average of one to 811-834 people.

On zooming into individual districts, one finds that the disparity widens further. For instance, while Budgam boasts of filling up 373 out of 411 regular medical posts and all 120 National Health Mission medical posts, creating an impression of adequate manpower, the paramedical manpower pool – the group of nurses, technicians and other supportive workers, whose efforts ensure the day-to-day running of a health centre, paints a different picture altogether, with merely 386 out of 1,290 regular paramedical posts and 512 out of 562 NHM paramedical posts filled, creating a total vacancy of 954 posts in this category.

Baramulla’s paramedical section stands at 420 of 675 regular posts and 704 of 806 NHM posts filled, a relatively moderate vacancy rate compared to its neighbours but still a meaningful gap in day-to-day care capacity.

The shortage issue is such a big one that the country’s Health Minister, Sakina Itoo, has stated publicly that about 16,000 posts are lying vacant in the state health department. Government Medical Colleges have their share of problems as far as staffing is concerned despite the fact that the region is also dealing with an increasing incidence of non-communicable diseases: 8 percent of the total population is affected by diabetes while 10 percent is pre-diabetic.

The problem of infrastructure further aggravates the problem of human resource shortage. In Jammu & Kashmir, there is only 0.9 beds per 1,000 inhabitants, which clearly falls short of the requirement for a population of more than 1.56 crore, and only 30% of the existing beds are situated in rural areas, where the population lives. Another academic study done on health care availability in rural Ganderbal district found that out of the total 84 community health centers existing in Jammu & Kashmir, only 45 centers have staff accommodation and only 29 centers have the facility of having residents’ doctors, thereby leaving many centers to work without any medical doctor at the center. Only 23 of these centers have the complete set of four important doctors, i.e., physician, paediatrician, gynecologist, and surgeon, and 17 centers don’t have the facility of operating theaters at all. The primary health centers, out of a total of 637 PHCs in the state, do not have the facility of electricity and water connection in almost 20%, and 58%, i.e., 375 PHCs lack the ambulance facility at the center.

Impacts of such shortcomings disproportionately affect the most vulnerable of these populations. For a woman who is pregnant in an isolated village, the lack of a doctor in the health center implies that she will have to make a long journey to a district/sub-district hospital, which becomes particularly risky in the event of complications, harsh winter conditions, and road blocks. The elderly patients and those requiring urgent attention are similarly disadvantaged, and research conducted into the health-seeking behavior of the people in Ganderbal district showed that residents tend to seek help from quacks and medical shops rather than formal institutions due to the unreliability and physical inaccessibility of these facilities.

Responses from the government have been in terms of recruiting campaigns and expansion through digital means. More than 480 positions of Medical Officers have been recommended to the Jammu and Kashmir Public Service Commission, with 834 positions being gazetted and 1,025 non-gazetted posts being recommended for recruiting along with contractual engagements under the National Health Mission to fill up the immediate voids. Chief Minister Omar Abdullah has personally handed over the appointment orders to the new recruits and called upon them explicitly to work in areas that lack infrastructure, asking them not to transfer themselves to the urban locations too quickly. Expansion of the digital health services, such as the e-Sanjeevani teleconsultations through the Ayushman Bharat Digital Mission, is taking place to enhance services in those regions which lack physical infrastructure, along with efforts to control tuberculosis and immunisation through Mission Indradhanush.

It is doubtful whether this will actually bring about any difference since there are other factors involved which extend beyond the mere number of recruits. The health sector experts emphasize the need for hardship allowance and incentives that will actually make it appealing for doctors to serve in such rural postings and not just as a temporary situation before they can get a transfer somewhere else. There is also a need for continuous development in terms of infrastructure from decent accommodation, good water supply and power supply so that a doctor can be able to operate in such areas. If the recruitment process does not deal with the reasons why doctors apply for transfers from rural postings, it may end up being a revolving door.

mdmuslimbhat@gmail.com