J&K - Policy and Political Context

THE STATE OF J&K

Jammu and Kashmir is the only state in India which enjoys special autonomy under Article 370 of the Constitution of India according to which, no law enacted by the Parliament of India, except for those in the field of defence, communication and foreign policy, will be extendable in Jammu and Kashmir unless it is ratified by the state legislature of Jammu and Kashmir. J&K is the only state in India which has a Constitution of its own. The Constitution of J&K was enacted by a separate Constituent Assembly set up by the State and it came into force in November, 1957.

THE STATE OF J&K

Jammu and Kashmir is also the only Indian state that has its own flag and constitution, and Indians from other states cannot purchase land or property in the state. Designed by the then ruling National Conference, the flag of Jammu and Kashmir features a plough on a red background symbolizing labour substituted the Maharaja's state flag. The three stripes represent the three distinct administrative divisions of the state, namely Jammu, Valley of Kashmir, and Ladakh. The three three divisions of Jammu & Kashmir are further divided into 22 districts: Jammu: 10 districts Kashmir: 10 districts Ladakh region: 2 districts

Constitution of J&K and Health

State Directive Principles: Section 24. Duty of the State to improve public healthThe State shall make every effort to safeguard and promote the health of the people by advancing public hygiene and by prevention of disease through sanitation, pest and vermin control, propaganda and other measures, and by ensuring widespread, efficient and free medical services throughout the State and, with particular emphasis, in its remote and backward regions.

State Initiatives
State PIP 2011-12: The administrative approval of the PIP for the State is conveyed for an amount of Rs 260.95Cr. The state shall focus on key NRHM goals of reduction in MMR,IMR & TFR and overall disease burden. Oct. 2009 - A High Level Task Force was constituted to oversee the progress in resolution of issues pertaining to Health & Medical Education Sector. Terms of Reference: i. To assess the problems related to Health and Medical Education Sectors, which affect the healthcare delivery system. ii. To suggest remedial measures for taking timely action in resolution of the problems. iii. To suggest measures for improving the healthcare services in primary, secondary and tertiary healthcare. iv. To oversee/monitor the progress of the same, etc. Composition: Chairman: Chief Minister Vice Chairman : Minister for Health

State Plans and Policies

State PIP 2011-12: The administrative approval of the PIP for the State is conveyed for an amount of Rs 260.95Cr. The state shall focus on key NRHM goals of reduction in MMR,IMR & TFR and overall disease burden. State Drug Policy (2009): Objective: to promote access to affordable essential medicines of adequate quality to the people of the State. -The concept of essential drugs/medicines is central to the State drug policy because it promotes equity and helps in setting priorities for the health care system. -Procurement, storage and transportation made easier, more transparent and more accountable through an autonomous Corporation.

POLITICAL SCENARIO
Governance : Like all the states of India, Jammu and Kashmir has a multi-party democratic system of governance. PoK : Pakistan continues to illegally occupy a large chunk of Jammu & Kashmir and does not allow the people here any freedom of choice. Human Right Issues: A pattern of harassment, intimidation, and deliberate disregard for the civil and political rights of those who are critical of the government has emerged over a period of time. Many of those detained are prisoners of conscience, held only for their peaceful political views. Insurgency : Military forces in Jammu and Kashmir operate under emergency powers granted to them by the central government. These powers allow the military to curtail civil liberties, creating further support for the insurgency. Support for government : The governments inability to protect the people from both its own troops and the insurgency has further eroded support for the government.

HEALTH NEEDS

Demographic, Socio-economic and Health profile of Jammu & Kashmir State as compared to India figures

INDICATOR

India

J&K

Birth Rate (SRS 2008) Estimated Death Rate (SRS 2008) Infant Mortality Rate (SRS 2008) Total Fertility Rate (SRS 2008) Population below Poverty line (%) (2008) Institutional Deliveries (NFHS-III) Full Immunization (NFHS-III)

23.1 7.4 55 2.9 26.1 40.70% 43.50% 65.8 m 68.1 f

19 5.8 51 2.3 3.48 54.30% 66.70% 65.0 m 67.0 f

Life Expectancy at birth (2008)

Disease Prevalence
DISEASE Malaria cases (2008) Prevalence of blindness (2003-04) Estimated blind persons (2003-04) HIV (JKACPS Aug 2009) Tuberculosis (NFHS III) Diabetes (NFHS III) Asthma (NFHS III) Goitre or other thyroid disorder (NFHS III) Leprosy J&K 200 cases 1.61% 1.62 lakhs

HR-0.3% LR-0.04%
211 cases 96/1lakh 540 w/1lakh 278m/1lakh 897 w/1lakh 816 m/1lakh 237 w/1lakh 0 men < 1/10000

Psychiatric Morbidity : Depression, post-traumatic stress disorders (PTSD) and generalized anxiety disorders (GAD. Trauma & Disability: Prevalent due to unstable political conditions and insurgency. Vulnerability : People fleeing a conflict situation survive in congested refugee camps in the state and areas are under siege by the army and by militants. This leaves the population vulnerable to problems of all sorts like sexual abuse, abysmal healthcare, and the absence of any public awareness programme. Geographic differences across districts including urban-rural differences and also due to different political scenario.

Militancy continues to engulf Kashmir and the refugees remain trapped in camps. In the absence of basic facilities like education, hygiene, medical infrastructure, and health awareness, Jammu and Kashmir confronts a threat as ugly as militancy itself

Womens Health
Social Factors Lack of education and awareness Violence against women Economic Factors Unemployment Low purchasing power Political Factors Lack of participation in political affairs Lack of decision making authority Poor and low status of women & children Morbidity Mortality and Malnutrition

Community Awareness and Needs

Awareness about Government health programmes: Women aware about danger signs of ARI Women who have heard of RTI/STI Women who have heard of HIV/AIDS Use of family planning methods: Any method (%) Unmet need for family planning Mothers who received any antenatal check-up Mothers who had full antenatal check-up Institutional births Children 12-23 months fully immunized Children 12-23 months not received any vaccination >60% approx. 58.7% 24.6% 62.7% 54.1% 21.6% 84.5% 29.3% 54.9% 62.5% 4.5 %

Source: DLHS 3 2007-08

However if one critically analyses the number of institutional deliveries and calculates the crude birth rate by only taking into account the institutional deliveries, the CBR for Jammu and Kashmir works out to be 19 per thousand population in 2006 and 2007 and 12.6 in 2007 and 2008. (FHS3 and other latest surveys conducted in J&K show that about 45 percent of births take place at home and if we adjust the births delivered at home the CBR for 2006 and 2007 works out to be 27 and for 2007 and 2008 CBR works out to be 18.27. While as the SRS has reported a CBR of 19 for the same period. This raises a lot of questions regarding the authenticity of number of institutional deliveries and JSY beneficiaries reported during 2007 and 2008 by the SPMU.

Community Perception
NRHM- CRM (Dec 07) : Expectation of the public from public system is very low in the state. Inspite of huge infrastructure, human and technical resources the public system is not the place of choice for the citizens.

Households not generally using govt. health facilities Reasons: No nearby facility Facility timing not convenient Health personnel often absent Waiting time too long Poor quality of care Other reason Perception of HW: Percentage of women with any contact with HW HW talked nicely HW made sure that she understood the information given

37.1% 33.2% 9.3% 5.9% 22.4% 55.3% 7.3% 14.1% 97.7% 83.2%

Source: DLHS 3 2007-08