By Arun Pratap Singh
Garhwal Post Bureau
Dehradun, 27 Jul: The fragile state of healthcare services in Uttarakhand, particularly in its mountainous and remote regions, has once again come under the spotlight with the 17th Common Review Mission (CRM) report of the National Health Mission (NHM. The latest report once again exposes serious gaps in medical manpower, infrastructure, availability of essential medicines and healthcare delivery. The report is based on an assessment carried out between January and October 2025 and it paints a worrying picture of a public health system struggling to meet even basic standards despite the state’s challenging geographical conditions.
For years, government hospitals in the state’s hill districts have functioned more as referral centres than fully equipped treatment facilities. While many institutions continue to grapple with an acute shortage of doctors and paramedical staff, others suffer from inadequate infrastructure, limited diagnostic facilities and poor availability of medicines. The burden of these shortcomings is borne primarily by patients, particularly those living in remote and inaccessible mountain areas, where access to healthcare remains a daily challenge.
According to the Common Review Mission report of the NHM, one of the biggest reasons behind the persistent shortage of doctors is the reluctance of medical professionals to serve in remote hill regions. As a result, a large number of sanctioned posts under the Indian Public Health Standards (IPHS) remain vacant which adversely affects both the accessibility and quality of healthcare services across the state.
The report observes that that the shortage of human resources has been aggravated by the fact that several serving medical officers are pursuing postgraduate studies while continuing to draw their salaries. Since they remain away from active clinical duties during PG training, hospitals face an even greater shortage of doctors. The report also points out that Uttarakhand is yet to establish a dedicated specialist cadre. Sources in the state health department and in the government however claim that the government is working on such a proposal.
In Uttarakhand, the Human Resources for Health (HRH) Cell has been constituted to strengthen workforce planning, but the crucial post of Programme Officer still remains vacant. Although the state has established an Internal Committee for the prevention of sexual harassment at the workplace and has prepared Terms of Reference for National Health Mission personnel, the report observes that NHM employees continue to receive limited preference during regular recruitment exercises.
Recruitment of doctors and other health personnel is presently being undertaken both at the block and state levels through annual contractual appointments. Specialist doctors and medical officers are largely recruited through monthly walk-in interviews, while Community Health Officers are recruited centrally at the state level. The government has also introduced the “You Quote We Pay” scheme to attract specialist doctors to difficult areas. The irony is however that many specialist doctors just don’t join even after their appointment and the approval of their desired salaries. Several others join but leave the job soon after. In the remote areas however, very few general practitioners let alone the specialists report regularly for duty.
The report reveals that nearly 99 percent of Uttarakhand’s approximately 2,577 primary and secondary healthcare institutions, including Sub Health Centres, Primary Health Centres (PHCs), Community Health Centres (CHCs), sub-district hospitals and district hospitals, were assessed for compliance with Indian Public Health Standards. Most of these facilities were found to fall under the “Aspirant” category, scoring between 25 and 50 percent. The poor ratings have primarily been attributed to a large number of vacant posts and the limited availability of trained healthcare personnel.
The report also finds that certification under the National Quality Assurance Standards (NQAS) remains extremely low in Uttarakhand. Only 47 healthcare facilities, representing about 2 percent of all the assessed institutions, have received certification. However, some encouraging progress has been made. Gopeshwar District Hospital received NQAS certification in 2024 and went on to win the Kayakalp Award in 2025 for improvements in cleanliness and quality standards, although several other hospitals now require re-certification.
District Quality Assurance Committees and hospital-level quality committees have been constituted across the state, but the report recommends strengthening their functioning through regular meetings and more active quality improvement teams at healthcare facilities.
However, the shortage is not restricted just to the doctors alone. Another major concern highlighted by the review is the shortage of essential medicines across government hospitals. Uttarakhand has officially notified an Essential Drug List for primary and secondary healthcare facilities, comprising 74 medicines for Sub Health Centres, 135 medicines for Primary Health Centres and nearly 690 medicines for secondary care institutions. However, the actual availability of medicines was found to be far below these prescribed levels.
Several Sub Health Centres were found to stock only 40 to 65 different medicines, while Primary Health Centres had between 54 and 80 different medicines available. Community Health Centres had only 76 different medicines, sub-district hospitals stocked between 93 and 132 different medicines, and the district hospitals had only 161 to 208 different medicines in stock, indicating considerable shortages even at the highest levels of government healthcare.
Medicines for non-communicable diseases such as hypertension and diabetes were found to be generally available, although shortages were reported in Udham Singh Nagar district. The report also notes that despite national programme guidelines recommending a month’s supply of medicines, many patients were receiving medicines for only three to fifteen days, forcing them to make repeated visits to hospitals and disrupting continuity of treatment.
The review further reports shortages of antiretroviral medicines in Udham Singh Nagar. Emergency medicine budgets were being utilised to procure medicines such as calcium tablets, Vitamin A, oral contraceptive pills and Glimepiride, indicating shortcomings in regular procurement and supply mechanisms.
The report identifies serious deficiencies in the state’s drug storage infrastructure. State and district drug warehouses were found to have inadequate storage space, poor temperature and humidity control, insufficient labelling, weak pest control measures and inadequate manpower for warehouse management. Equally concerning is the absence of a dedicated transport system for medicine distribution.
As a result, patients or hospital staff often have to travel personally to collect medicines from state or district warehouses, significantly affecting the efficiency of the supply chain. Although systems for drug quality testing and quarantine of medicine samples exist, the report recommends substantial improvements. Not only, this, sources claim that in Uttarakhand it is common for the government doctors to prescribe branded medicines suggesting the patients to purchase the medicines from private medical stores instead of prescribing Jan Aushadhi or generic medicines.
Diagnostic services across Uttarakhand are currently being delivered through a combination of government facilities and Public-Private Partnership (PPP) arrangements. More than 260 diagnostic tests are available under PPP-operated laboratories, whereas in-house diagnostic facilities in many government hospitals remain limited. The report also raises concern over the unnecessary prescription of biochemical investigations such as Liver Function Tests, Kidney Function Tests and Lipid Profile tests for outpatient cases by some doctors, recommending regular prescription audits to curb irrational testing.
The review points out that while the state has constituted the supervisory committee under the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act and held a meeting in August 2025, district-wise, block-wise and village-level reports identifying areas with adverse sex ratios have not yet been prepared. The online registration portal envisaged under the Act is also yet to become operational.
Mental healthcare too requires greater attention. Although the State Mental Health Authority and review boards have been constituted under the Mental Healthcare Act, 2017, the report notes that only one meeting was held during the year. At the same time, disability certification boards are functioning under the Rights of Persons with Disabilities Act, and awareness programmes are being organised.
The report observes that medico-legal protocols are being followed in cases of rape and sexual violence and that procedures under the Medical Termination of Pregnancy Act are being implemented wherever required.
Maternal healthcare services, including antenatal and postnatal care, are available in most health facilities and beneficiary tracking systems are in place. However, Maternal and Child Health records and high-risk pregnancy registers were found to be incomplete at several facilities. Some districts also reported shortages of digital haemoglobinometers, calcium supplements and Vitamin A injections.
The review highlights that difficult terrain continues to hinder healthcare delivery in remote hill regions. Home deliveries are still being reported from some inaccessible villages, while patients are often transported to hospitals using traditional dandi-kandi carriers because of poor road connectivity. The report also notes that many Accredited Social Health Activists (ASHAs) lack adequate awareness regarding incentives linked to high-risk pregnancies and postnatal care.
As per the Common Review Mission report, the government health system is being undermined by severe shortages of doctors and healthcare workers, inadequate availability of medicines, weak storage and logistics systems, uneven access to diagnostic services and the absence of strong public health leadership.
