Healthcare in Jammu and Kashmir remains a critical concern, with systemic gaps affecting service delivery, especially in rural and remote areas. Despite the appointments of over 290 doctors in 2024, specialist shortages persist, infrastructure remains unevenly distributed, and administrative bottlenecks hinder optimal utilisation of medical professionals.
The Human Development Index (HDI) and high unemployment rate in Jammu and Kashmir (46% unemployment in educated youth) further exacerbate the crisis, with underutilised medical professionals contributing to the paradox of high unemployment amid dire healthcare needs.
Under the Central Civil Services (CCS) Rules, the standard workweek is 42 hours, spread over six days (7 hours/day). Any extra duty requires compensation via overtime pay or compensatory leave.
Doctors in government medical colleges and health departments often miss gazetted holidays, which should be compensated monetarily or through earned leave. Like all professionals, doctors also deserve work-life balance to care for their families.
Night duties in medical colleges and district hospitals must be officially recognised and compensated, with adequate night-offs for the rest. If senior doctors or consultants are assigned night shifts in emergency sections, their weekly hours must still adhere to the 42-hour limit (7th CPC norms), ensuring proper night-offs.
But this poses a key question; if senior doctors are on night duty with restricted daytime availability, who will handle critical daytime patient care and administrative responsibilities?
In March this year, on the floor of the assembly, Health Minister Sakina Itoo revealed that Jammu and Kashmir is grappling with a severe shortage of medical consultants, with 290 posts lying vacant across hospitals.
Against a sanctioned strength of 852 consultants, only 562 are currently filled. While 60% of vacancies will be filled through JKPSC recruitment, 40% await DPC clearance.
The acute shortage of 23 senior consultants further burdens the healthcare system, demanding urgent action to bridge the gap and improve patient care.
While World Health Organisation (WHO) recommends 1:1000, doctor- patient ratio, however, many countries, including India, have a different ratio. India has been reported to have a ratio of 1:834, which is better than the WHO standard.
Ironically, one doctor is available for treating over 1,800 patients in J&K under the doctor-to-patient ratio by 2025.
Moreover, the Central Bureau of Health Intelligence (CBHI), which is the national nodal agency responsible for health intelligence in India, plays a crucial role in providing data and reports related to healthcare resources, including the number of doctors and their distribution across different regions.
According to the National Health Profile 2018, published by the CBHI, one doctor served 3,060 people in the region, which was far above the recommended ratio of 1 doctor for every 1,000 people.
This ratio has not improved significantly over the years, as the number of government doctors in Jammu and Kashmir was 2,892 in 2022, showing a marginal increase from 2,739 doctors in 2021. Despite this increase, the ratio of doctors to patients continues to be a challenge for healthcare delivery in the region.
The data reached an all-time high of 4,058 doctors in 2016 and a record low of 2,185 doctors in 2008. Number of Doctors data in J&K remains in active status in CEIC and is reported by Central Bureau of Health Intelligence.
At present, the ratio stands at one doctor for 4,840 people, which is much below the national average. Moreover, it will take many years to close the gap created by shortage of doctors in J&K.
Key Challenges in Healthcare Delivery
Shortage of Specialists and Uneven Distribution
The Doctors Association Kashmir (DAK) has already highlighted the acute shortage of Consultants and Senior Consultants across specialties like Radiology, Anesthesia, Dermatology, and Psychiatry. While Jammu Division has 19 Consultant Radiologists, Kashmir has only nine, with no Senior Consultant posts in the valley, although the population of Kashmir valley stands around 8.56 million as compared to 6.34 million of Jammu province by 2025.
Similarly, Gynecology has four Senior Consultants in Jammu but none in Kashmir or even Ladakh.
Several District Hospitals (DHs) and Sub-District Hospitals (SDHs)—such as those in Kulgam, Pulwama, Kupwara, Bandipora, and Ganderbal—have CT scanners and Doppler machines but no sanctioned Radiologist posts. This undermines evidence-based diagnostics, a cornerstone of effective treatment.
Underutilisation of Post-Graduate Doctors
Medical Officers (MOs) with Post-Graduate (PG) qualifications are often posted in Primary Health Centres (PHCs) instead of SDHs or DHs, where their expertise could be better utilised. Additionally, the current duty roster system—where doctors work 48-hour shifts followed by five days off—reduces daytime availability, affecting patient care.
Administrative Disparities
A major systemic flaw is the appointment of MBBS-qualified doctors as Block Medical Officers (BMOs), Chief Medical Officers (CMOs), and Medical Superintendents (MS), while Consultants and Senior Consultants work under them. This creates hierarchical conflicts and inefficiencies.
A significant portion of administrative roles, such as Deputy CMO, CMO, DHS, DIO, Assistant Director, Deputy Director, and Director, should be allocated to Consultants and Senior Consultants. These positions should be shared equally (50:50) between medical officers and Consultants at the district level and above.
Lack of Incentives for Rural Postings
Unlike hill states such as Himachal Pradesh, J&K lacks structured incentives for doctors serving in remote and peripheral areas. This discourages specialists from working in rural settings, worsening healthcare disparities.
Proposed Reforms for a Robust Healthcare System
There are several short-term and long-term measures that need to be taken to set the health care system on rails.
As an immediate measure, there is need to create Consultant & Senior Consultant Posts including urgently sanctioning specialist posts in underserved districts, particularly in Radiology, Anesthesia, and Gynecology.
Until permanent posts are created, specialists under the National Health Mission (NHM) can be deployed as a stop-gap arrangement to man critical diagnostic infrastructure.
The duty rosters need to be revamped with a replacement of the 48-hour shift system with pre- and post-night offs to ensure better daytime doctor availability.
For long-term structural reforms, administrative roles for specialists should be reserved for qualified professionals, with only PG-qualified doctors holding positions like BMOs, CMOs, and MS to ensure competent leadership in healthcare institutions. To improve accessibility and incentivise specialists, paid evening clinics should be introduced at SDHs, DHs, and GMCs with a revenue-sharing model of 80:20 between the institution and the specialists running these evening OPDs.
A transparent transfer policy needs to be implemented in phases to ensure equitable distribution of medical professionals. The first phase should focus on transferring doctors who have served 10 or more years in one location. After a year, the second phase should relocate those with 7 or more years of service, followed by those with 5 or more years, creating a systematic approach to staff redistribution.
Secondly, there is a need for expanding Rural Healthcare access. For this, new Type PHCs (NTPHCs) should be established at cluster levels, with village dispensaries set up in every hamlet to improve healthcare access in remote areas. If funding becomes a constraint for this expansion, exploring public bonds specifically for local healthcare infrastructure development could provide an alternative financing mechanism.
To make remote postings more attractive to healthcare professionals, the system should introduce hardship allowances, provide better housing facilities, and offer enhanced career progression benefits similar to those implemented in other hill states. These incentives would help address the challenge of recruiting and retaining qualified medical staff in underserved rural areas.
The Way Forward
The J&K administration must act swiftly to:
1. Fill Specialist Gaps: Prioritise recruitment and promotion of Consultants in underserved districts.
2. Optimise Human Resources: Post PG-qualified MOs at SDHs/DHs, not just PHCs.
3. Leverage Medical Tourism & Employment: Utilise unemployed doctors to boost healthcare delivery while addressing joblessness.
4. Community Participation: Engage locals in healthcare financing through bonds if government funds fall short.
Chief Minister, Omar Abdullah, and Health Minister Sakina Itoo must treat this as a public health emergency.
Without immediate reforms, the healthcare system will remain fragmented, leaving millions without quality care. Strengthening SDHs, DHs, and new GMCs is not just a necessity—it is the key to saving lives in Jammu and Kashmir.
“The time to act is now.”
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