Four voices on the NHM question in Jammu and Kashmir: the employees, the money, the medicine and the men and women in between.
INTRODUCTION
This Sunday, we turn the page over to a question that has stayed unanswered for too long.
Who keeps a health centre open in a village at eight in the morning? Who walks up a slope in winter to weigh a baby? Who answers when a woman in labour is brought in at night? In much of Jammu and Kashmir, the answer is a worker hired under the National Health Mission.
They are not new to the system. Many of them have been in it for fifteen years or more. They ran the immunisation drives. They sat at the testing counters during COVID-19. They filled the registers that the reports are made from. Yet on paper, most of them are still contractual.
This month, that quiet arrangement broke into the open. NHM employees went on strike on September 9. The strike was extended more than once. On September 18, after a written assurance from the Health and Medical Education Minister, the association deferred the agitation for one month. The government has constituted a committee to examine the demands and work out a roadmap. Not everyone among the employees is satisfied with the way this was done, and that debate is now public.
So the strike has paused. The question has not.
We carry four pieces on this page. They do not agree on everything, and we have not asked them to. Inam Un Nabi writes about dignity and the promise an elected government has made. Dr Fiaz Maqbool Fazili looks at pay, retention and what a fair review package would contain. Peerzada Masarat Shah writes with a sharper pen about stipends that have not moved since 2019. Dr Noor Ali Zehgeer asks what happens to medicine itself when the people who practise it are treated as casual labour.
Before the arguments, the numbers. We have set out below what is on record about the National Health Mission in Jammu and Kashmir: how many people it employs, what it costs, how much of that money comes from Delhi, and where it goes. Some of these figures are easy to find. Some are not, and we have said so plainly rather than fill the gap with a guess.
A system is finally judged by how it treats the people who run it.
NHM IN JAMMU AND KASHMIR: THE NUMBERS ON RECORD
Employees
More than 12,000 NHM employees in Jammu and Kashmir, by the count of their own association. Figures placed in Parliament by the Union Health Ministry list over 8,600 NHM health professionals for Jammu and Kashmir and Ladakh together, counted by category: 153 specialists, 550 general duty medical officers, 904 AYUSH doctors, 1,926 staff nurses, 3,860 ANMs and 1,719 allied health workers. The two counts measure different things. The association’s figure includes staff outside these clinical categories.
Yearly spending
Rs 1,180.71 crore was spent under NHM in Jammu and Kashmir in 2025-26. The year before it was Rs 1,110.30 crore, and Rs 956.95 crore in 2023-24. These totals include central grants, the UT share and unspent balances carried forward, and are provisional.
Central contribution
Rs 1,017.14 crore was released by the Centre under NHM in 2025-26. Releases rose from Rs 459.10 crore in 2021-22 to Rs 651.52 crore, then Rs 805.22 crore, then Rs 1,040.76 crore in 2024-25. Over the five years to 2025-26, central releases under NHM totalled Rs 3,973.74 crore, with a further Rs 171.25 crore under PM-ABHIM. For 2026-27, Rs 163.53 crore had been released up to July 13. Nationally, NHM has been given Rs 39,390 crore in the Union Budget for 2026-27.
Spending on employees
There is no separately published figure for the total salary bill of NHM staff in Jammu and Kashmir. What is on record is the release of Rs 150.84 crore in May 2026 for salaries of NHM and outsourced staff, DNB stipends and ASHA incentives for 2026-27, of which Rs 65.49 crore went to the Directorate of Health Services Kashmir and Rs 46.29 crore to Jammu. Human resources is the single largest head of NHM spending in most states. In Andhra Pradesh, to take one comparison, Rs 1,008.50 crore of a Rs 2,447.98 crore plan for 2026-27 is for salaries. NHM also ordered a five per cent increment for all contractual employees in J&K for 2025-26.
Spending on medicines
Not in the public domain in any current form. Medicines for government hospitals are procured and distributed by the J&K Medical Supplies Corporation, and are given free at government institutions. The Corporation’s annual procurement value has not been published recently. This figure would have to be sought from the Health and Medical Education Department.
Infrastructure
Under the NHM infrastructure head, Rs 600 lakh was approved for Jammu and Kashmir in 2025-26 and Rs 578.47 lakh was spent, about 96.4 per cent. Under PM-ABHIM in the same year, Rs 49.69 crore was released and Rs 89.56 crore spent, the difference coming from earlier balances and the UT share. The J&K budget for 2026-27 carries Rs 1,866 crore as capital allocation for Health and Medical Education.
NHM EMPLOYEES HAVE SERVED J&K. NOW J&K MUST STAND WITH THEM
By Inam Un Nabi
Think of the health worker who leaves home before sunrise to reach a health centre in a remote village. The nurse who spends long hours attending to patients. The ASHA worker who walks from door to door, checking on mothers and children. The paramedic who responds when somebody needs help urgently. The employee who continued reporting for duty when the entire world was frightened by COVID-19.
For the patient, they are not “contractual” or “regular”. They are simply the person standing there when healthcare is needed.
For years, hundreds of NHM employees have carried this responsibility across Jammu and Kashmir. They have worked in cities and villages, in hospitals and health centres, in difficult and far-flung areas. They have supported immunisation, maternal and child healthcare, disease-control programmes and countless other public-health initiatives. And when COVID-19 struck, they were among those who stood on the frontline. They served when the system needed them most.
Today, many of those same employees are asking a very simple question: after giving the best years of our lives to public service, when will the government give us some certainty about our own future? That question deserves to be heard.
The present agitation by NHM employees is therefore much bigger than a salary dispute. It is about dignity, job security, fairness and recognition of years of service.
Imagine working for 15, 18 or 20 years and still not knowing what your future holds. You raise a family. Your children grow up. You plan your life around your employment. You serve the government and the public year after year. Yet, on paper, you remain contractual.
This is the human face of the NHM issue. Regularisation cannot simply be treated as an administrative file moving from one office to another. Behind every such file is a family, a career and a person who has spent years serving the people of Jammu and Kashmir.
The employees are seeking a time-bound regularisation or absorption mechanism, job security, pay revision, equal pay for equal work, service rules, social security, retirement benefits, timely salaries and other protections. Not every demand can necessarily be implemented overnight. There can be legal, financial and administrative questions. But a difficult problem is not the same thing as an impossible problem. What is required is the political will to find a lawful and workable solution.
The most frustrating part of this entire episode is that the issue has been discussed for years. There have been meetings. There have been representations. There have been committees and assurances. But the employees are still asking the same questions. What is the policy? Who is eligible? How many vacant sanctioned posts are available? What legal mechanism can be used for absorption? What will be the financial implication? What can be done immediately? And, most importantly, when will it be done?
The government may not be able to solve everything in one order. But it can certainly provide a roadmap. People can live with a difficult journey when they know where the road leads. What they cannot live with is endless uncertainty.
The Omar Abdullah government came to power with promises to address the concerns of employees and different sections of society. NHM employees are now looking towards that promise.
The Chief Minister and the Health Department should take personal ownership of this issue and bring all stakeholders to the table. The employees need more than another assurance that their case is “under consideration”. They need a written commitment, a defined process and a timeline.
If regularisation requires examination of vacant posts, let that exercise begin. If recruitment rules need amendment, start the process. If legal opinion is required, obtain it. If financial support is required, pursue it. If the Centre’s intervention is needed, go to Delhi and pursue it relentlessly. That is what an elected government is expected to do.
There is another important dimension which cannot be ignored. The Government of India has made it clear in Parliament that public health and hospitals are State/UT subjects, while the Centre provides financial and technical support under NHM. The Union Government has also clarified that matters relating to health human resources and creation of regular posts fall within the domain of the State/UT administration.
This makes the responsibility of the elected government even greater. If the Government of India is leaving no stone unturned in pushing money and resources to Jammu and Kashmir, then our elected government must leave no stone unturned in pursuing the interests of its people.
Funds do not automatically become policies. Schemes do not automatically become jobs. And announcements do not automatically become justice. There has to be serious pursuance, continuous engagement and political ownership. If J&K needs greater financial flexibility, the government should pursue it with Delhi. If additional resources are required, ask for them. If a policy intervention is needed, make the case. If there are legal hurdles, find a lawful way forward. This is what seriousness in governance means.
Sometimes government discussions reduce employees to numbers and financial implications. But an NHM employee is not merely a line in a budget. He or she is a parent, a son or daughter, a husband or wife, someone paying school fees and household expenses, and someone who has spent years acquiring experience and serving patients. When such a person works for decades without a secure service framework, the uncertainty affects an entire family.
We must therefore look at the NHM issue not only through the lens of government expenditure, but also through the lens of human dignity and public service.
At the same time, there is an important responsibility on both sides. NHM employees are part of the healthcare system, and prolonged disruption inevitably affects ordinary patients, particularly poor families and people living in remote areas. The government must therefore move quickly towards a negotiated settlement. The employees should not have to choose between fighting for their future and protecting the patients they serve. The best solution is one that protects both.
The present crisis gives the Omar Abdullah government an opportunity to finally put this long-pending issue on a structured path. The government can identify eligible NHM employees and their length of service, examine vacant sanctioned posts across the Health and Medical Education Department, work out a legally sustainable absorption or regularisation mechanism, address genuine pay disparities, frame comprehensive service by-laws, strengthen social-security and retirement provisions, establish a transparent transfer mechanism, address hardship faced by employees serving in remote areas, ensure timely payment of remuneration and publish a clear timeline for each stage.
Even where immediate regularisation is legally difficult, the government can provide certainty about the route towards a solution. That alone would change the atmosphere.
NHM employees have already proved their commitment. They have served Jammu and Kashmir through ordinary days and extraordinary crises. They have gone where the system needed them. They have worked when resources were stretched. They have stood beside patients when patients needed them most. Now they are asking the government to stand beside them.
National Conference government led by Omar Abdullah should fulfil the promise made to them. The Government of India should be approached wherever financial or policy support is required. And the J&K administration must demonstrate the seriousness, persistence and political ownership needed to bring this issue to its logical conclusion.
This is not about winning an argument with employees. It is about restoring their confidence in the system they have served for years.
NHM employees have spent the best years of their lives serving the people of Jammu and Kashmir. They should not spend the rest of their careers wondering whether the government will ever recognise their service.
While writing this article, I came to know that NHM employees have called off their strike following assurances and commitments from the government. That is a welcome development, particularly because the continuation of the strike could have affected patients and healthcare delivery across Jammu and Kashmir.
But calling off a strike should not mean that the issue itself is now forgotten. In fact, this is where the real responsibility begins.
The employees have shown faith in the government’s word by returning to work. The government must now show that this faith was not misplaced. Whatever has been promised to the NHM employees must be followed by visible action, proper documentation and a time-bound process. Every assurance must translate into movement on the ground.
Because trust in public life is built on one simple principle: when a government gives its word, it must honour it.
If promises are made only to end an agitation and are then allowed to gather dust in files, the next time people will understandably ask why they should believe another assurance.
The government therefore has an opportunity to convert this moment of de-escalation into a moment of confidence. NHM employees have called off their strike. Now the government must ensure that the reasons for which they called it off are honoured in letter and spirit.
The employees returned to their duties. Now it is the government’s turn to return to its commitments. That is how trust is built. That is how governance is measured. And that is how people begin to believe in their elected government again.
A TEN-POINT REVIEW PACKAGE
By Dr Fiaz Maqbool Fazili, expert on healthcare policy analysis and advisor on healthcare reforms
The concerns being raised by JKNHMEA regarding salary disparities deserve serious and compassionate consideration. This is not merely an issue of pay; it is fundamentally a healthcare workforce, retention and patient-care issue.
When competent doctors and healthcare professionals feel that their remuneration, working conditions and professional opportunities are significantly less favourable than those available elsewhere, dissatisfaction inevitably grows. Over time, this can contribute to migration towards corporate healthcare and other regions, resulting in the loss of valuable talent from the public health system of the UT.
A meaningful comparison should not be restricted to basic salary. Total compensation must be considered: basic pay, allowances, working hours, night duties, emergency responsibilities, risk exposure, geographical hardship, housing, professional development and career progression. A doctor serving in a difficult, remote or high-altitude area cannot necessarily be compared with someone working under substantially different conditions.
The first step should therefore be an objective salary and benefits-gap assessment. The Government should undertake a transparent comparison of the total remuneration of doctors and other healthcare professionals in the UT with comparable states and Union Territories. This should identify specific gaps and establish a time-bound roadmap for addressing them. What should be included in a review package? I suggest 10 points.
1. Hardship and remote-area allowance: Meaningful additional compensation should be provided for difficult, remote, high-altitude, border and underserved postings, based on objective criteria.
2. Rationalised Kashmir/territorial allowance: Where justified by service conditions, a transparent allowance should be introduced or strengthened and periodically reviewed.
3. Specialist retention allowance: Scarce specialties and highly trained professionals should receive additional incentives, particularly where recruitment and replacement are difficult.
4. Emergency, night-duty and on-call compensation: Additional duties should be recognised through transparent and predictable financial compensation.
5. Retention bonus: Doctors and other critical healthcare professionals completing defined periods, such as three or five years, of continuous public service could receive a retention incentive.
6. Housing and HRA support: Government accommodation should be expanded wherever feasible; where unavailable, HRA should realistically reflect local housing costs.
7. Professional development: Government-funded CME, conferences, fellowships, certifications, research opportunities and skill-upgradation programmes can strengthen both morale and professional growth.
8. Career progression: Time-bound promotions, selection grades, transparent promotion criteria and opportunities for academic advancement are essential. Financial incentives alone cannot compensate for stagnation in professional careers.
9. Family and social support: In difficult postings, assistance related to children’s education, transportation and comprehensive health and occupational-risk insurance could significantly improve retention.
10. Transparent transfer and tenure policy: Predictable tenure, fair transfers and protection against arbitrary displacement are powerful non-financial incentives and can substantially improve professional satisfaction.
However, salary reform alone will not solve the problem. Doctors also need adequate staffing, functional equipment, medicines, diagnostic facilities, safe workplaces and reasonable workloads. Excessive administrative responsibilities and chronic understaffing can drive professionals away even when remuneration improves. The Government should therefore establish a Healthcare Workforce Retention and Compensation Council, with representation from government, professional bodies such as JKNHMEA, administrators and independent healthcare experts. It could annually review remuneration, vacancies, attrition, workload, transfers, professional development and retention indicators. The objective should not simply be identical salaries everywhere. It should be fair and evidence-based total compensation for comparable work, with additional recognition for difficult service conditions.
The Government should view expenditure on healthcare professionals not merely as a recurring cost but as an investment in the health system. Losing an experienced specialist means losing years of training, institutional knowledge and patient relationships. Retaining that professional strengthens the entire system. A sustainable policy should combine pay parity, hardship and specialist incentives, duty compensation, housing, career progression, professional development and better working conditions. This comprehensive approach can reduce dissatisfaction, address legitimate concerns and retain
