Health schemes fail to reach women in rural Kashmir

Over the years, different government schemes have been introduced to reduce out-of-pocket expenditure on health services for the public. These include the AB-PMJAY scheme that offers financial coverage of up to INR 5 lakh per family per year for hospitalisation and treatment, and the Janani Shishu Suraksha Karyakram (JSSK) that provides pregnant women and newborns free services at government health facilities. 

Together, these schemes are designed to ensure that families do not have to bear the cost of essential maternity care. However, for communities living in the remote and rural areas of Jammu and Kashmir, this promise is still unfulfilled. 

AB-PMJAY has been extended to the union territory as part of the SEHAT scheme. For women who deliver babies in government facilities, SEHAT’s insurance-based model works alongside JSSK. The latter expands the scope of health support to cover cashless delivery and caesarean-section services, medicines, diagnostics, blood transfusions, and transportation. However, access to these benefits depends on women being able to reach the public health facilities in the first place. 

Since local health facilities do not offer adequate services to support deliveries, families have no option but to travel to larger hospitals.

Rifat Kalsan, a new mother who resides in Kangan tehsil’s Narnag village, Ganderbal district, says, “We live in a far-flung area in the mountains. Reaching the hospital is difficult for us, and sometimes we have to travel on horses. During labour, an ambulance service built to reach women in such remote areas would make a big difference.” 

Hajra, an ASHA worker in the area, adds that even if an ambulance takes patients to the hospital, families often have to pay for fuel.  

Rukhsana Khatana, a resident of Gujjar Pati village in the same district, says that seeking care in the city also means additional costs. “We do not have heavy vehicles or accessible transportation, so going to the hospital itself is difficult and expensive. Even an ambulance costs INR 1,500–2,000. When we go to a government hospital, we have to arrange for many things ourselves and spend money on medicines, food, and accommodation. Even something as basic as a blanket can become a burden for us.”

While SEHAT and JSSK have widespread coverage on paper, there is still a lack of awareness about the schemes. Mehnaaz Choudhary, a resident of Takhyabal village in Kangan, shares that she did not know about SEHAT even while seeking treatment at a government hospital. “This is the first time I am hearing about the scheme. Other women in my family don’t know about it either.” 

Hajra adds that awareness about the schemes is not universal, and many families came to know about them only through frontline workers. Further, while women don’t have to separately enrol under JSSK to access benefits, SEHAT requires beneficiary identification through the scheme’s database, with Aadhaar being the primary mode of identification. This can add to the complexity of accessing the scheme.

Dr Masooma Rizvi of LD Hospital adds that while treatment and diagnostic tests are covered under JSSK and SEHAT, gaps in the administrative and referral system pose challenges for patients travelling outside their district for treatment.

“If a patient comes from south Kashmir to central Kashmir for treatment, and the same treatment is already available at the district hospital there, it may not be possible to process the patient under the scheme because a question will arise about why they did not visit their district hospital,” Masooma says.

 “Only the administration can properly comment on why these gaps exist and why patients may still have to pay,” she adds.

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