Author : Niranjan Sahoo

Expert Speak India Matters
Published on Feb 07, 2020
Decoding Aam Aadmi Party’s health card report 

Beyond education, Aam Aadmi Party (AAP) government has generated considerable public attention on measures adopted to overhaul national capital’s healthcare system. Its famed mohalla clinics model (neighborhood health clinics), multi-specialty polyclinics, free medicines and surgeries for 30 life threatening diseases, promise to quickly add 30,000 more beds in government hospitals, novel concept of bike ambulances among others have received rave reviews. So much so, even Ban Ki-moon, former Secretary General of United Nations commended AAP government’s health initiatives particularly the three-tiered network of Mohalla clinics, polyclinics and multi-specialty hospitals to widen access to healthcare for poor and the needy. A quick stocktaking of major health initiatives by AAP throws up interesting facts, some good and some not so good.

Major Spike in Health Spending

In the run-up to the assembly elections in 2015, AAP had pledged to transform National Capital Territory (NCT)’s ailing healthcare system by infusing more funds, improving health infrastructure, getting more health professionals, expanding primary healthcare in the neighborhoods among others. After assuming power, the first thing that AAP government did was to increase the funds for healthcare. From a measly sum of Rs. 3,300 crore in 2015-16 to Rs. 7,484 crore in 2019-20, the health sector budget has seen a quantum jump (See Graph). Delhi’s total expenditure on healthcare is much bigger than the average of many large states in India.

Figure – 1 Budgetary Allocation to Health Sector

Source: PRS, Delhi.

Mohalla Clinic Model

Beyond enhanced public funding, AAP government took slew of relevant measures to expand healthcare facilities. The government through its three-tiered network of Mohalla clinics, Polyclinics and Hospitals launched many schemes to provide free medicines, tests and surgeries for critical illnesses. However, the most talked about schemes by AAP is the Aam Aadmi Mohalla Clinic (AAMC). These clinics were designed to provide quality primary healthcare services at an extremely low cost to people in the neighbourhoods. The mohalla clinics provides services such as basic medical care for common illnesses like fever, diarrhea, respiratory problems, first aid for injuries and burns and referral services among others. According to some reliable studies, mohalla clinics are making significant dent in people especially the urban poor having increased access to basic healthcare. Further, these clinics have played a critical role in reducing the out of pocket expenditure of people from jhuggi jhopris (slums or temporary housing colonies). As of now, AAP government has rolled out 490 Mohalla clinics in Delhi and official report suggests more than 2 crore OPD patients have benefitted from these clinics.

Alongside mohalla clinics, AAP government created multi-specialty polyclinics (largely converted many existing dispensaries) to strengthen the second tier of the health system. Polyclinics intended to focus on secondary healthcare in the form of OPD consultation by specialist doctors, including diagnostics. Till October 2019, the AAP had created 26 polyclinics in Delhi. At the third tier, AAP considerably invested to strengthen the hospitals system. So far, the government has tied with 41 private hospitals in Delhi to facilitate 30 surgeries free of charge for patients referred by government hospitals in the capital.

These apart, AAP government has made modest progress in strengthening Delhi’s creaking healthcare infrastructure sector, the government strived to improve the infrastructure in the hospitals. While the government has consciously invested in improving the number of health clinics, polyclinics, nursing homes among others to address the deficiency in primary healthcare system, it has simultaneously attempted to improve the number of beds in government hospitals. According to the Department of Health, while 10,959 beds were available in 2014-2015, it has  gone up to 11,353.  Further, according to government statement, three hospitals under construction would likely to add another 2800 beds in next six months. On the whole, last five years of AAP government has witnessed a flurry of activities to strengthen Delhi’s public health system.

A Long Road Ahead

While national capital’s ailing public health system has received much needed booster shots by incumbent AAP government, the health story is not without its share of troubles and shortcomings.  The promises made in its 70-point manifesto for improving healthcare are far from being fulfilled.  The numbers (health infra) speak a volume of AAP’s struggle to deliver its promise on quality and affordable healthcare for Delhi citizenry. While the party had pledged to add 30,000 more beds in government hospitals, only a fraction (394 beds in 38 hospitals) of promise was fulfilled in first four years. While Delhi’s peculiar jurisdictions as national capital territory, bureaucratic delay, administrative clearance from the Centre including issues of land have had a clear bearing on the outcome, yet AAP government cannot deny its own failure in falling on this critical mission of expanding tertiary health infrastructure. In fact, acute shortage of beds invited a stinging observation from the Delhi High Court in 2019. The High Court also made negative observation regarding the shortage of intensive care units (ICUs), malfunctioning ventilators.

Further, notwithstanding many claims in improving bench strengths of health professionals, Delhi government run hospitals continue to face acute shortage of medical and para- medical manpower. According to a recent report titled “The State of Health in Delhi”, there is 66% shortage of medical lecturers, 34% shortage of medical Staff (Doctors, Surgeons and Specialists), 29% shortage of para medical staff, 22% of nurses. The hospitals also lack 40% administrative staff and 38% labor.

With regard to famed mohalla clinics, while this novel scheme as generated a lot of attention and rightly so, it is far short of reaching its original target. While the government had pledged to have 1000 such clinics, by the end of its tenure there are only 490 such clinics, of which 152 were added in last December.

Above this, the overall performance of the Delhi government does not compare well with the performance of similar Union Territories and smaller states of the Union in the healthcare sector. According to the report by NITI Aayog in collaboration with World Bank, “Healthy States, Progressive India: Report on the Ranks of States and UTs”, Delhi ranked lowly on 5th out of 7 UTs with a score 50.2.

To sum up, while AAP government has initiated a flurry of activities on healthcare and has succeeded in creating a buzz via many novel schemes such as mohalla clinics, bikes ambulances, free medicines and surgeries, health for all, many structural and governance problems afflicting public health system remain unaddressed. While one cannot forget the complex administrative and political environment (with an adversarial Union Government) in which AAP government has to constantly struggle to get required land, clearances from the Lieutenant Governor and other bureaucratic apparatus, AAP government cannot deny its own failures to plan for such eventualities in complex policy landscape. Yet, AAP’s energy and number of initiatives including greater public funding have done well to revive the hope for a neglected public health sector and has done well to bring the much-needed spotlight on healthcare. Any future government will have to continue with the momentum.

Niranjan Sahoo is Senior Fellow, ORF and Bhavayta Mahajan is research intern, ORF

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Niranjan Sahoo

Niranjan Sahoo

Niranjan Sahoo, PhD, is a Senior Fellow with ORF’s Governance and Politics Initiative. With years of expertise in governance and public policy, he now anchors ...

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