Abstract
The study explores themes pertaining to access and utilization of healthcare embedded in Penchansky’s framework, viz. availability, affordability, accessibility, acceptability and accommodation, in conjunction with Anderson’s model of healthcare utilization amongst the transhumant pastoralist community of Bakarwals residing in Pir Panjal Range of Jammu and Kashmir. Bakarwals are fundamentally transhumant, but hordes of them sedentarized after militancy and conflict in the area reached its crescendo. Transhumants oscillate in space-time continuum, so it is imperative to conduct sample surveys due to non-existence of systematic surveillance data pertaining to health status and access of this group. The study employed a mixed method approach and took place during the reverse migration cycle from summer higher grazing pastures (dhoks) in the twin border districts of Poonch and Rajouri, comprising 250 structured questionnaire interviews coupled with 100 semi-structured interviews. Pir Ki Gali, Jammia Gali and Nurpur Gali transhumance routes were purposefully selected for discerning qualitative inquiry to yield cases with maximum information. A facility survey encompassing 12 primary health centres, three community health centres and two district hospitals was also conducted to ascertain supply-side factors in Bakarwal-concentrated areas. Results indicated lesser probability of utilization in higher pastures (dhoks) due to amalgamation of factors like geographical inaccessibility of modern medicine and cultural preference, but this is less pronounced in winter settlements and amongst the sedentarized. Demand for modern healthcare is also not commensurate with the supply for the same, exacerbated by non-availability of health professionals, drugs and poor quality of service provision found in the facility survey.
Highlights
Transhumance pastoralism is embedded in unique and diverse functional, social, cultural, spatial and environmental structures and institutions
Transhumant pastoralists in India have a low human development index and high relative deprivation index, and to add to the caveat, they are often under-represented in government institutions and lack political empowerment
Mutual distrust between transhumant pastoralists and government structures poses a barrier to utilization of available services
Summary
Transhumance pastoralism is embedded in unique and diverse functional, social, cultural, spatial and environmental structures and institutions. Transhumance is a viable eco-social system which involves regular and cyclical seasonal movements of pastoralists along with their livestock between areas situated at different elevations and having different physical and climatic conditions It describes the seasonal oscillation or periodic vertical shifts typically in mountain regions from winter to summer ranges. Kaulis and Kinnauras in Himachal Pradesh and Gujjar Bakarwals scattered over parts of Jammu and Kashmir All these herders continue a long-standing tradition of migrating up to the alpine pastures of the high Himalayas for the summer and descending to the low-lying Himalayan foothills in the winter. Since independence of India, the pastoralists of Himalayas have faced a series of significant alterations stemming from external political and economic changes These structural alterations have bought adjustments in many aspects of the traditional pastoral system, including their migratory cycle, local economy and social organization (Bhasin 2013). Even in emergency cases, they have to walk long distances resulting in poor health outcomes
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