Having garnered international appreciation from the likes of former U.N. Secretary Generals Kofi Annan and Ban Ki-moon for its accessibility and effectiveness, compared to healthcare in general in India which is ranked at a lowly 145 on the global healthcare access and quality (HAQ) index, the incumbent AAP government of Delhi is inevitably using his government’s health care initiatives as one of its major electoral campaign planks.

With the AAP government making education and health its top priorities, Chief Minister Arvind Kejriwal launched several schemes to provide free medicines, diagnostics and several life-saving surgeries through a three-tiered network of Mohalla Clinics, Polyclinics and Hospitals. The Mohalla Clinics, which function as primary health care centres, charge no fees and have been set up at 158 locations across the city, each staffed by a doctor, pharmacist and clinic assistant and are located in porta cabins or rented premises. Renowned cardiac surgeon and founder of Narayana Health, Dr Devi Prasad Shetty, visited a mohalla clinic in Todapur and expressed amazement at the facilities provided.

“While some clinics work from 8 am, to 2 pm, those with double shifts are running between 7 am and 1 pm and 1 pm to 7 pm with two different sets of staff members, including doctors,” said a health department official. The clinics, functional on all days except Sunday, provide basic medical care for common illnesses like fever, diarrhoea, skin problems, respiratory problems, first aid for injuries and burns, dressing and management of minor wounds and referral services. It also allows 212 types of lab tests by the empanelled laboratories. The clinics also provide medicine free of cost.

Deepak who sells bread in Mayur Vihar was bitten by a dog and was treated free at the nearby Mohalla Clinic in the East Delhi colony of Trilokpuri, where two such clinics are located. “I found their treatment good and was given free medication. The only problem is one has to spend a lot of time waiting for his turn,” said Deepak.

These clinics are now providing primary health care to previously unserved communities. Diagnosis, medicines and tests are all free of cost in Mohalla Clinics. But success brings with it some problems, such as the large number of patients visiting the clinic to avail of the free treatment, numbers the clinics probably never anticipated or were designed for. According to available figures, at least over 200 to 300 persons visit these clinics, located near lower income colonies, daily.

“Though we have to wait in a long queue for our turn to be checked by the doctor, it is better than spending money at a private clinic where apart from the charges by the doctor which sometimes is almost about Rs 300 for every visit, the cost of medicine is also equally high and we spend almost all our earnings on health care,” said Deepa, who works as a maid in one of the housing societies in Mayur Vihar Extension.

As of now, the mohalla clinics and polyclinics are functioning only at 10 to 15 per cent capacity, but once fully functional they will help de-congest government hospitals, said officials. Delhi’s government hospitals currently have to cope with huge numbers of patients. In 2016, these hospitals registered 30 million OPDs which went up to 40 million in 2017.

“We will cover at least 50 million OPDs,” said Health Minister Satyendra Jain. “We are providing free of cost medicines and tests, so many are coming from nearby states as well. The increase in OPDs itself shows that the services have been enhanced. For example, the Delhi government has tied up with certain private labs which conduct MRI, PET scans and ultrasounds for free for poor citizens. Till now, over 5,000 scans are conducted in these labs per month.

The AAP government also launched 23 Polyclinics, with a target of 150 such polyclinics that offer specialised diagnosis and treatment to poor patients for free. This, in turn, is expected to reduce the out-patient burden on government hospitals enabling them to focus on quality in-patient care.“We are taking measures to reduce the burden on government hospitals while simultaneously ensuring timely treatment for patients,” said Health Minister Jain. Referring to the Mohalla clinics, Jain said the cost of construction of 1000 mohalla clinics is estimated at Rs 200 crore and its operation per year will cost Rs 400 crore. For the existing 158 clinics, the operation cost comes to around Rs 30 crores yearly.

A Mohalla Clinic in a porta cabin at Doosra Pusta in Khajuri Khas. Pic: Vishwas

Transformation of government hospitals

The Delhi government runs 38 full-fledged hospitals across the city including the Janakpuri Super Speciality hospital, Rajiv Gandhi Super Speciality Hospital, Govind Ballabh Pant Hospital, Aruna Asaf Ali hospital and Lal Bahadur Shastri Hospital. Over the last two years, the government has significantly improved conditions in these hospitals. The state has made all medicines, tests and surgeries at these hospitals completely free.

Further, if patients who are residents of Delhi are waitlisted for a life-threatening surgery at a Delhi government hospital for more than 30 days, the hospital refers the patient to any one of its 31 private centres and 57 empanelled private hospitals, which treats the patient for free within 15 days. For the first time, even expensive tests like CT scans and MRIs are being conducted for free. “We lay emphasis on health and education, there will be no dearth of funds for this scheme,” said Kejriwal. The cost of these procedures, for which no upper limit has been set, will be paid by the Delhi government.

As part of the expansion process, about 1016 surgical, 123 oncology and 10 neonatal procedures and six medical packages are now part of the 86 surgeries already covered under the Delhi Arogya Kosh (DAK). This includes implants as well as treatment for vector-borne diseases. Also, the AAP government’s Farishte Dilli Ke scheme ensures that regardless of domicile or income status, anyone can be taken to any hospital (public or private) in case of an accident and the government will pay for the entire treatment.

As one beneficiary of the health facility of the Delhi Government said: “We were referred to a speciality hospital and the Delhi government reimbursed the entire amount of Rs 1 lakh for surgery.”

However, several private doctors approached by this correspondent refrained from commenting on the health scheme. “It is controversial and don’t want to say anything,” said one doctor, while another said “I don’t know the full scheme so would not like to say anything about it.” Private hospitals too did not respond to queries.

The administration runs other schemes under the Delhi Arogya Kosh that incorporate private healthcare providers (1,155 surgeries and procedures, as well as 133 diagnostic tests can be availed cashlessly in private empanelled facilities). There are plans to open six new government hospitals, while the government has more than doubled the bed capacity of existing hospitals by upgrading infrastructure and diagnostic and treatment facilities. All citizens of Delhi are currently entitled to free medicines, OPD, lab tests and hospitalisation at the state-run healthcare facilities, with cashless referrals to private providers when required.

According to figures given out by Satyendra Jain, till end of June 2019, a total of 1,34,609 patients had benefitted from the scheme for free diagnostics facilities like MRI, CT, PET CT, Nuclear, USG and Doppler, Mammography, at 23 empanelled private labs. Also, 4,654 patients received cardiac, urinary, general, eye and ENT surgeries, and lap-cholecystectomy among other treatments. Further, 2,938 road accident victims and one acid attack victim were treated free from February 15, 2018 till June 30, 2019. “The Delhi government bears the cost of treatment at many multi-speciality hospitals in the city,” added Jain.

The Delhi government announced an allocation of Rs 7,485 crore for the health sector in its budget, with Rs 588 crore being proposed for construction of new hospitals and re-modelling of existing ones. Deputy chief minister Manish Sisodia presented a Rs 60,000 crore budget for 2019-20 in the Delhi assembly laying emphasis on education, health and transport. “I propose a total outlay of Rs 7,485 crore on the health sector for 2019-20. This includes revenue budget of Rs 6,462 crore and capital budget of Rs 1,023 crore. An amount of Rs 3,737 crore is earmarked for implementation of various health schemes, programmes and projects”.

The Delhi government also said that given the health care initiatives it has taken, there is no need for it to implement the Centre’s Ayushman Bharat scheme. “This claim is baseless,” said Dr. Harsh Vardhan, Union Minister of Health and Family Welfare. ““All your fancy schemes await implementation. Your Mohalla Clinics too are an utter flop”. That, however, is not a sentiment with which many Delhiites agree.

Meanwhile, the Delhi High Court refused to entertain a plea which alleged that the AAP government’s health scheme, being implemented by the Delhi Arogya Kosh (DAK), was “discriminatory” as only residents of Delhi have access to it. A bench of Chief Justice D N Patel and Justice C Hari Shankar questioned the manner in which the petition was drafted. “Such petitions are filed just to make it a sensational matter. This is a Publicity Interest Litigation,” the bench observed.

Also read: Delhi loves its Mohalla Clinics, but can they really improve public healthcare?