J&K’s Referral Transport Costs Surge Under NHM

Post by : Amit

Photo : X / Office of Chief Minister, J&K

Referral Transport in J&K: From Lakhs to Crores, NHM’s Bill Soars

Over the past five years, Jammu and Kashmir’s health transport infrastructure has undergone a dramatic transformation—not just in its reach, but in its cost. What began as a modest service under the National Health Mission (NHM) to transport pregnant women, children, and critical patients from remote locations to hospitals, has now become a sprawling logistical operation with an annual expenditure that has skyrocketed—from a few lakhs to several crores of rupees.

Data sourced from the J&K Health and Medical Education (H&ME) Department shows that the referral transport expenditure under NHM, which stood at modest levels a few years ago, has now swelled to unprecedented figures. For many public health experts and administrators, this exponential increase is both a sign of progress and a red flag calling for urgent attention.

As government-commissioned ambulances crisscross the Union Territory’s vast and mountainous terrain, the growing cost burden raises pertinent questions: Is this money being spent efficiently? Has the demand really gone up so much? And more importantly, is the system delivering the outcomes it was designed for?

From Remote Calls to City Hospitals: How Referral Transport Works

Referral transport under the National Health Mission is a critical element of maternal and child health (MCH) services, particularly in geographies like Jammu and Kashmir where terrain, weather, and infrastructure often delay timely access to care.

The transport network consists of a fleet of ambulances, both government-operated and outsourced through public-private partnerships (PPPs). These vehicles are dispatched from health sub-centers or block hospitals when frontline workers or family members report complications, labor, emergencies, or infant illness requiring specialist intervention.

Over the last decade, schemes like Janani Shishu Suraksha Karyakram (JSSK) and Janani Suraksha Yojana (JSY) have supported thousands of pregnant women by providing free transport, delivery services, and neonatal care. In Kashmir, where many communities live in hilly or isolated areas, such interventions have saved countless lives.

However, with the number of referrals rising—and with a corresponding jump in operational budgets—the sustainability and transparency of this growing transport infrastructure is now under the scanner.

The Numbers Tell a Story of Surge and Strain

According to official records reviewed by Rising Kashmir, the expenditure on referral transport under NHM in J&K has grown more than tenfold in the last five years. While specific district-wise breakdowns are yet to be made public, internal audits confirm that the figures have jumped from tens of lakhs in the early 2020s to multiple crores annually by 2024–25.

A senior health official, speaking on condition of anonymity, stated:

“This increase isn’t entirely unexpected. There’s greater awareness, more institutional deliveries, and an improved reporting system. But it’s also true that there is inadequate oversight on transport routing, repeat calls, and private ambulance outsourcing.”

A deeper analysis reveals three main drivers of this budgetary expansion:

1. Increased institutional deliveries as part of NHM's push for safer childbirth.
2. Expanded ambulance coverage, including in previously underserved districts like Kupwara, Bandipora, and Kishtwar.
3. Greater reliance on third-party operators, particularly during high-demand periods, which often leads to cost inflation.

A Welcome Sign of Access or a Systemic Overspend?

Health economists are divided in their reading of the data. On one hand, the increased spending could signal a positive trend: more people are reaching health facilities in time, fewer women are giving birth at home without medical supervision, and neonatal mortality has reduced in several districts.

“Referral transport is the backbone of maternal and child health in regions like J&K,” says Dr. Saika Nisar, a public health researcher based in Srinagar. “If costs have gone up, it's likely because access has improved. That’s not necessarily a bad thing.”

However, not everyone is convinced. There are growing concerns over:

• Lack of a centralised dispatch system leading to overlapping or redundant ambulance deployments.
• Private ambulances billing multiple trips for a single referral.
• Ambulances being misused for non-emergency, VIP, or unrelated inter-facility transfers.

A 2023 audit conducted by the State Health Society had flagged several instances of inflated bills and poorly maintained logbooks. It also noted that while GPS devices had been installed on many vehicles, real-time tracking and route optimisation had not been enforced uniformly.

District-Wise Trends: Who’s Driving the Surge?

Though detailed data is not publicly available, insiders say that Kupwara, Baramulla, Anantnag, and Poonch districts have reported some of the highest referral transport usage rates. This corresponds with their challenging topography, sparse specialist coverage, and larger rural populations.

Urban centers like Srinagar and Jammu, by contrast, show a relatively balanced usage of referral services, as tertiary hospitals are more accessible and private transport is often an option.

Block-level disparities are also emerging. In some blocks, frontline health workers (ASHAs and ANMs) are praised for efficient coordination of ambulance services. In others, there are reports of delays, duplication of calls, and referral misuse for routine, non-emergency cases, leading to congestion and inflated costs.

The Human Face of the Transport Challenge

In villages like Tangdhar, near the Line of Control, or Dachnipora in South Kashmir, even a small improvement in transport availability can mean the difference between life and death.

“I went into labor at 2 a.m. and we had no vehicle,” recalls Zeenat Bano, a 27-year-old mother from Handwara. “The ASHA worker arranged an ambulance. I was taken to Kupwara hospital in time, and my daughter is healthy today. I’m grateful, but many women still don’t get such timely help.”

Stories like Zeenat’s are common. But so are complaints from health workers who say they struggle to get ambulances on time or are forced to use private vehicles in the absence of timely dispatch, later claiming reimbursement under NHM—which is another cost not always accounted for transparently.

NHM Responds: Efficiency Measures in the Pipeline

Officials from the National Health Mission, J&K, acknowledge the rising expenditure and have assured that monitoring protocols are being tightened.

According to a spokesperson for NHM J&K:

“We are introducing GPS-based dispatch systems, QR code tracking for patient movement, and central call centres to avoid duplication. District nodal officers have been instructed to audit ambulance logs monthly.”

The department is also considering:

• Dynamic allocation of ambulances based on GIS mapping of demand.
• Integration with telemedicine services to triage cases remotely before dispatch.
• A centralised online dashboard for tracking each ambulance trip, outcome, and cost.

These measures, if implemented sincerely, could cut down unnecessary rides, reduce costs, and build public trust in the referral system.

Experts Warn of Burnout and Inefficiency

As NHM tries to balance demand and cost, human resources remain a challenge. Drivers are often overworked, with reports of 24-hour shifts during emergencies. Some blocks do not have a backup vehicle, leading to delays when the lone ambulance is already on duty.

“There’s a silent crisis of burnout among ambulance drivers and dispatchers,” says Dr. Mushtaq Ahmad, a primary health officer from Rajouri. “Their role is life-saving, yet their working conditions remain unregulated.”

He also warns of donor fatigue if NHM funds continue to be diverted toward operating costs rather than infrastructure, training, or diagnostics. “Transport is vital, but it should not eat up the health budget.”

A Broader View: What This Says About Health Access in J&K

The surge in referral transport expenditure is a window into broader systemic issues in J&K’s public health architecture. While access has improved, specialist care remains unevenly distributed. Most patients still need to travel from remote areas to tertiary hospitals, often covering 100 km or more.

Unless the state invests in:

• Strengthening sub-district hospitals,
• Deploying more obstetricians, paediatricians, and anaesthetists, and
• Enabling teleconsultation or e-ICU models in remote zones,

the pressure on transport infrastructure will only rise.

Moreover, community awareness, demand-side monitoring, and frontline worker incentives must be revisited to align expectations with what the system can realistically deliver.

Time to Steer With Caution

Jammu and Kashmir’s dramatic rise in NHM referral transport spending is a story of both success and strain. More people are getting to hospitals. More women are delivering in safe environments. But at what cost, and with what outcomes?

As the Union Territory’s health administration navigates this complex terrain, it must balance scale with sustainability, reach with regulation, and urgency with accountability.

Because in healthcare, getting someone to the hospital in time is just the beginning. What happens next is what truly saves lives.

J&K, Transport, National Health Mission