Manoj Kumar Dwivedi,
Secretary, Health & Medical Education Department,
Government of Jammu & Kashmir

During the last 12 months, the state of J&K has shown more improvement in the field of healthcare as compared to any other state in the country,

Kindly tell us about the initiatives that your department  is taking to bring improvement in the healthcare  facilities that are available to the people in the state?
The State Health Department is dedicated to achieve universal basic healthcare for all the citizens of the state. We are  making great efforts to ensure that the quality of healthcare  becomes better in all our secondary and tertiary hospitals. I  would say that the primary mandate of the State Health Department is to ensure that primary healthcare system gets  further boost and every person is able to access quality  healthcare in this geographically difficult state. There should  be a primary healthcare centre within one kilometre distance  of every citizen in rural and urban areas. This will bring about  a dramatic improvement in the health status of the citizens,  especially those who are living in the rural areas. The idea is to  provide access to equitable, affordable and quality healthcare  to all. We are focussed on reducing Infant Mortality Rate and  Maternal Mortality Rate, stabilising the population and ensuring that the gender and demographic balance is maintained.  So this is what we are trying to achieve at the primary level,  and we also realise that at the secondary and tertiary level, we  have to upgrade the quality of healthcare. All the parameters  of healthcare that are the indicators of the quality of health-  care, i.e., IMRI the overall fatality rate, birth rate, are being  taken into account, to enable us to develop better methodologies for healthcare delivery.

How is e-Governance in healthcare leading to the improvement in the kind of care that the common man receives?
Lot of new e-Governance initiatives in healthcare have been  taken, and it is pleasure to inform that according to new data,  during the last 12 months, the state of J&K has shown more improvement in the field of healthcare as compared to any other  state in the country. The use of new technology in the field of  healthcare has definitely had a role to play in the development  of healthcare in the state. We have a system in place to closely  monitor the health of mother and children. There is an efficient  mother and child tracking system in place to update the state  government on their health parameters and nutrition factors.  We are developing a system through which data can be collected at block level through the computer and fed into the  overall health database of the state. We are also having a system where health workers in villages can use mobile phones  with preloaded software to collect and transmit information.

What kind of mobile software will this be?
It will basically be a Java based application, with a very easy to use interface. The healthcare workers will be able to feed the parameters of the data related to pregnant ladies in an area, children born in that area. The data will get automatically transmitted to the block level and uploaded on our servers. It is necessary for the state of J&K to use mobile based systems because unlike other states we dont have a State Wide Network; however, the penetration of mobile telephony is at 90 percent. Steps are being undertaken to further upgrade the mobile based monitoring systems. We also have a wide network of ambulances; more than 800 ambulances are attached to various healthcare stations for transportation of patients to healthcare centres. The ambulances will soon be outfitted with GPS tracking systems so that their movements can be monitored through a Central Monitoring System. The Hospital Management System is already being implemented in different hospitals. We are starting with two hospitals, one in Jammu region and the other in Kashmir. In both these hospitals we are planning to have end to end computerisation of the entire hospital system.

According to you what are the main healthcare projects of the states that had been immensely successful and have the potential to be replicated?
The application that has given the best result is actually the implementation of Janani-Shishu Suraksha Karyakram  (JSSK). This is a key sponsored scheme under the National   Rural Health Mission. In J&K the MMR rate is better than the  national average, but we are endeavouring to reduce it further. So we are having in place lot of facilities like free medical check ups, free medicine, free compulsory medical check ups for mothers. We are also setting up lot of community health- care centres, which are proving to be very effective in providing healthcare to our citizens.

What steps should be taken to ensure that the government owned health care centres, especially those in rural areas, are fully manned?
The biggest challenge that we face has to do with the shortage of doctors and staff nurses. To overcome this challenge, we have introduced the scheme of incentives. We have divided the difficult areas into three categories difficult areas, very difficult areas, and inaccessible areas. Difficult areas are those areas that are very far from cities, but are accessible through roads. The very difficult areas are those which are not completely accessible via roads, they require little walking distance. Inaccessible areas are those which are cut off with snow in winters, we are talking about places like, Ladhakh, Kargil. In the incentive scheme for doctors that we have started the doctors employed in the National Rural Health Mission Scheme get incentive of 20000, 15000, and 10000 depending on the nature of the area where they are serving. This has started giving results and now doctors are willing to serve these areas. Earlier we had about 200 posts vacant in these areas and now only 10 “ 15 post are lying vacant.

What are other challenges that you face in developing healthcare in the state? What are the solutions for overcoming these challenges?
The other big challenge is that of infrastructure, there are large numbers of primary and sub-primary healthcare centres which are being run in rented buildings. Obviously this is a big challenge because doctors are not ready to serve where there is no facility for providing medical care. So we are trying to upgrade the infrastructure in every part of the state. The third challenge that we face is that of lack of nursing training schools, and lack of medical colleges. We presently produce 300 doctors every year from the state, but we actually need more than 1000 doctors. The seats in the medical colleges have to be increased Similarly there is lack of trained nursing staff. We train about 400 nurses every year, whereas we need 1000 nurses for various districts in our state.

What is your opinion of the medical training that is available in the state? Is it at par with the training that is available in other parts of the country?
There is no doubt that we are lagging in the aspect of medical education. We are lagging in that and it is also a problem that no one is likely to come from other states for serving in this difficult state. For improving medical education, we have taken steps to introduce fast track learning courses at our teaching facilities. We are also making it possible for the professors at our institutions to get promoted quickly. As there was shortage of faculty, we have made changes in our recruitment rules to make it possible for more people to apply for the jobs.

In your opinion what kind of experiences and sensibilities as an administrator, must a health secretary bring to his job? How do you tackle the challenges and the pressures that are part of your Job?
The healthcare sector is very different compared to other sectors. Even if there are lot of private sector participation in healthcare, and we have hospitals like Apollo, Max and others, we still need government involvement in healthcare to ensure that the poorer section of the population is taken care of adequately. As an administrator my focus is on developing policies that are for the poor. Healthcare sector is also difficult because the human resource in this sector is difficult to manage. So the job of the administrator is to develop policies that can attract more talent. We have to provide adequate incentives for the doctors and other healthcare staff to join the mission of proving better healthcare to all. We have to have an open mind so that we can have the cooperation of all the Panchayats and people from diverse areas of the state.

Before becoming a Health Secretary, you had been an IT Secretary. Which job you find more satisfying and more challenging?
Being an IAS officer, I have to move from one department to the other. There are some departments like Finance and IT where the activities happen on a broader scale. I say this in the sense that these two departments develop policies and systems that can have an impact on every other department. As IT secretary I had the chance of being involved in the development of IT solutions that were being used in the healthcare segment. So when I came to the Healthcare sec- tor, I was already conversant with the IT systems with which the healthcare sector can be revitalised. Immediately after joining the healthcare segment, I have started the initiative of updating our websites. We are now making active usage of social media to dish out health related information to the public. Lot of new initiatives have been taken for computerising the healthcare delivery systems.

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