The test of a government’s commitment to health rights is not in its policies, but in its last clinic, its poorest village, and its most marginalised mother: Paul Farmer
Healthcare is not a privilege; it is a fundamental right guaranteed under Article 21 of the Indian Constitution. Yet, in the rural belts of Kashmir, this right often remains unrealised. While the government has introduced various health schemes to ensure medical access and affordability, the ground reality reveals a disturbing gap between policy and practice. It is deeply frustrating and disheartening to witness the persistent inefficiencies and neglect in the healthcare system in the rural areas of the Kashmir Valley.
Ideally, healthcare should be efficient, transparent, responsive, and accessible to all—but the ground reality is far from this vision. The system, in many ways, has failed the most vulnerable citizens, particularly poor women, postnatal patients, and those with no voice in administrative matters.
The healthcare system operates at the intersection of governance, policy, and ground-level execution. A weakness in any of these areas directly affects the delivery of services. In the rural areas of the valley, the absence of accountability, digital literacy, and administrative responsiveness has turned a citizen’s right to healthcare into a struggle for survival. In rural areas, residents have a crucial responsibility to collaborate with the health department to improve their health and well-being. This includes seeking timely healthcare, participating in community health programs, and advocating for improved healthcare access. Specifically, residents should leverage available health facilities, maintain good hygiene practices, and stay informed about public health messages.
As a citizen, I feel let down by a system that should serve, not exploit. I speak not just for myself, but for thousands of rural senior citizens and women who suffer silently. The lack of timely payments, the denial of honorariums, the presence of untrained staff, and the corruption in service delivery are not isolated issues—they represent a larger, systematic collapse in healthcare governance. People living in rural areas possess the same fundamental health rights as those in urban settings and have the right to be treated with dignity and equity. In rural areas, health departments have a multi-dimensional role. They are responsible for improving community health, ensuring equitable access to services, and reducing health disparities. This includes assessing health needs, preventing diseases, managing outbreaks, and responding to natural or health emergencies. They also work to promote hygiene, nutrition, and healthy lifestyles.
What we have seen and experienced about health rights, and how we are being treated—let’s take a closer look.”One of the most glaring and often overlooked violations of health rights in rural Kashmir is the execution of core medical duties by non-skilled and non-qualified staff. In many government health facilities, especially Sub-District Hospitals (SDHs) and community Health Centres (CHCs), individuals appointed for non-medical roles such as clerks, attendants, or sanitation workers are found performing basic medical tasks—from checking vitals to administering injections. This is not just a breach of protocol, but a direct denial of the constitutional right to quality healthcare. How Primary Health Centres fulfil their healthcare responsibilities remains questionable.
The root cause lies in staff shortages, poor accountability, and a culture of informal delegation, where untrained employees are forced—or allowed—to carry out medical functions in the absence or negligence of trained personnel. This not only endangers patient safety but also leads to gross exploitation of rural populations, many of whom are unaware of their rights or lack the confidence to question authority. I experienced this failure personally. When I accompanied my mother to the community health centre Pakherpora for a simple blood pressure (BP) check, we were met with indifference and absurdity. Upon approaching the so-called “doctor sahib” on duty, we were bluntly told. “BP is not measured on Sundays.” Such a response, apart from being medically irrational, reflects institutional apathy and a clear denial of essential care. BP monitoring is a basic, denying it—on any day—reveals either a lack of trained staff or a complete abdication of duty. Later, action was taken by the then CMO Budgam.
More disturbing is the fact that, in some hospitals, sweeper-class or clerical staff are reportedly given stethoscopes or BP monitors and made to handle patient care—not by merit, but due to the absence of regulation and casual attitudes within the system. They often justify denial of service with excuses while capitalising on the low literacy of patients, who often accept such misconduct as the norm. The incident at CHC Pakherpora is not isolated—it is symbolic of a wider crisis where the right to proper medical care is replaced by informal, unprofessional, and unsafe practices.
In rural areas of Kashmir, late arrivals and early departures by medical staff have become routine, severely affecting patient care. Many patients, often from remote villages, arrive early only to find doctors have left before OPD hours end. During working hours, doctors engage in unnecessary discussions with medical representatives (MRs), diverting time meant for patients. Unethical ties with private medical shop owners lead to biased prescriptions and unjust financial pressure on poor patients, despite it can be avoided easily. These practices violate both professional duties and citizens’ health rights, reflecting a lack of accountability.
In Kashmir, key maternal health schemes such as the Janani Suraksha Yojana (JSY) and the Janani Shishu Suraksha Karyakram (JSSK) are designed to provide financial and healthcare support to pregnant women. While these schemes play a vital role in improving maternal health outcomes, their implementation remains inconsistent, particularly in rural and remote districts. Due to low community awareness, delays in disbursement, and mismanagement at the facility and administrative levels. Many eligible women either do not receive the promised honorariums or face lengthy delays due to technical glitches, lack of documentation support, and non-cooperative hospital staff.
Although the Jammu and Kashmir government didn’t disclose the unspent amount of maternal health schemes, surveys such as NFHS, SWOC, Kashmir-specific studies, and NHM indicate that, based on a thorough review of available databases, there has been systemic fund underutilization and implementation gaps from 2019 to 2023. Despite policy efforts, the underutilization of maternal health scheme funds remains a persistent problem in the Kashmir Valley.
For instance, during 2020–23, the approximate unutilized funds in different districts were as follows: Anantnag 33%, Baramulla 36%, Budgam 31%, Kupwara 38%, Pulwama 33%, Shopian 32%, Kulgam 37%, Bandipora 40%, Ganderbal 39%, and Srinagar 24%. Districts like Bandipora (40%), Ganderbal (39%), and Kupwara (38%) recorded among the highest unutilized allocations under schemes such as JSY and JSSK. Meanwhile, delays in post-delivery payments in rural districts showed poor performance, with Bandipora and Kupwara experiencing the longest delays—consistently 5–7 months between 2019 and 2022. Urban districts like Srinagar and Jammu had the shortest delays.
Ultimately, unutilised and delayed scheme benefits perpetuate a cycle of neglect, where rural women are systematically excluded from the very support designed to empower and protect them. This is not just a policy failure—it is a denial of dignity, rights, and maternal justice. Delayed honorarium payments imprint a cycle of mistrust, vulnerability, and systemic failure on the rural healthcare landscape. Addressing these delays through timely DBT systems, grievance redressal, and strict accountability is essential not just for financial delivery but for the dignity, safety, and empowerment of women in rural areas of Kashmir.
The healthcare system in Kashmir is in urgent need of radical transparency, strict enforcement, and people-centric reforms. Until then, the poor will continue to suffer, and government schemes will remain only on paper. The first step towards change is recognising the failures openly and honestly, and demanding a system that truly delivers health with dignity, efficiency, and justice. We must remember that Healthcare is not measured in working hours or calendar days—it is measured in human accountability.
The writer works in the Education Department
Rayeesul Islam
ra************@***il.com