Rashid Paul

History of stagnant fiscal resource allocation fails J&K’s health sector

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“Conflict has become a shield hiding behind it the administrative incompetence”

Srinagar: “Conflict is development in reverse.” And Kashmir is a living example proving this World Bank assertion!

Take health sector, for instance. The public expenditure on health is far less than the spending on internal security. The centrally-administered territory spends nearly Rs 27 crores a day on maintaining “peace” (internal security) while as its daily expenditure on healthcare is only Rs 17 crores.

Despite genuine medical and administrative endeavors, the former state’s forsaken health system has caved in amid the rage of the COVID-19 pandemic. “It is the price which the former state is paying for the baggage of a beleaguered history,” say experts.

Analyzing financial statements of the past five years it manifests that the security considerations remain heavy on the policy planners and budget managers of Jammu and Kashmir. The revenue and the capital expenditures for the health and medical education are consistently trading off in favor of the security.

The erstwhile state in 2017-18 had an estimated budgetary expenditure of Rs 76335 crore. Its administrative and developmental outlay on health sector was Rs 3509 crores while as the allocation for Home department was Rs 6043 crores.

The estimated outlay for health in 2018-19 was Rs 3528 crore and for Home it was Rs 5753 crore. In the subsequent fiscal, expenditure for health was Rs 4448 crore and for Home it was Rs 7797 crore.

Similarly its projected spending on health was Rs 6169 crore and Rs 9215 crores for Home in 2020 -21.

Even during the corona infested current fiscal, the monetary resource allocation gap is again very wide between the two. Health sector has an allocation of Rs 7066 crore while as for the Home department it is Rs 10248 crore.

The erstwhile state during the past five years also spent Rs 3084 crores on logistics of the state security forces under the classification ‘security related expenditures (SRE)’.

This money was used up on raising the India Reserve Battalions, mobilization of the forces, ex-gratia relief to the victims of militancy, honorarium to village defense committees and Special Police Officers.

However, the central government under a non-plan scheme reimburses the SRE for the states affected by militancy or insurgency.

A “beleaguered” background of Jammu and Kashmir is being attributed by the experts for the low public spending on social sectors, especially the health services.

“The relative sectoral allocation since 1947 has been determined by the overall geo-political considerations. So there has always been a trade off with other sectors,” said Dr Javaid Iqbal Khan, political economist at University of Kashmir.

He says that the administration in this kind of situation has a natural compulsion to prioritize security and mainstreaming the polity.

But the “compulsive prioritization” of security has had a debilitating effect on the people’s health and the overall health system.

Recent COVID-19 modeling estimates for India by Center for Disease Dynamics Economics and Policy and Princeton University, USA (recently reported by ‘Kashmir Images’) reveal that Jammu and Kashmir has one of the poorest health infrastructure indicators in India.

The sum total of its hospitals, acute care units, beds and ventilators is critically low in comparison to the neighborly states of Himachal Pradesh, Utrakhand and even some tiny North Eastern states.

The hospital bed strength in J&K, according to a latest edition of ‘Digest of Statistics’ (excluding a few hospitals) is 18,106.  When this number is linked with its (projected) population of 1.36 crore people, it has one hospital bed available for 751 persons.

The statistics tell that J&K government has 30,432 medical personnel including 7,706 doctors, which makes it one doctor for every 1,764 people. The World Health Organization (WHO) recommends a ratio of 1:1000.

“A forlorn health system is not the issue afflicting Kashmir only. It is common to almost all the third world countries including India and Pakistan,” says Dr Abdul Hamid Zargar, former director of Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Kashmir.

“In fact health-care parameters in Kashmir are better than many of these places,” he added.

But Kashmir has been facing the issue of stagnant government expenditure on health for a very long time which has far-reaching effects, said Dr Zargar.

“During my administrative experiences I have realized that budgetary allocations in medical sector actually remained stagnant and are only inflation adjusted,” he said.

“How you can expect optimal health-care with a stagnant fiscal resource allocation?” he asked.

The experts also attribute the present account of health system to an “institutional failure”.

“Conflict has become a shield hiding behind it the administrative incompetence. Political and situational uncertainty do have a devastating effect on institutions, but in case of Jammu and Kashmir it has turned out to be more detrimental,” said economist Dr Javaid Iqbal Khan.

The economist substantiates his assertion saying almost no hospital was burnt down or medical professionals killed even during the peak years of the armed conflict in Kashmir.

Recalling his experiences with government, the former SKIMS director Dr Zargar said that in 2008 he prepared a detailed project report for upgradation of the Institute at a cost of Rs 250 crores. By the time the state authorities submitted it to New Delhi for financial approval, the cost of the project had escalated by Rs 100 cores.

Zargar, also an acclaimed endocrinologist, suggested the government to revisit its approach towards health sector and also realign the resources with the demands in the healthcare sector.

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