"This is complete propaganda," said Delhi Congress president Ajay Maken at a press conference on Thursday about the operation of more than 100 mohalla clinics, a flagship initiative of the Delhi government under the Aam Aadmi Party.
“As a responsible opposition, we felt the need to do a systematic survey of mohalla clinics,” said Congress party worker Ruchi Gupta, who helmed the survey.
It is not very often that we see a political party taking an interest and talking about about health policy, flawed or otherwise. However, in August, the Congress sent out 217 party workers in Delhi to survey the mohalla clinics in their respective areas. The survey seemed to have been conducted methodically with briefings on survey techniques before and follow-up briefings after the exercise.
The surveyors called jan sarvekshaks took photographs, filed Right to Information applications, and filed complaints based on their findings that the clinics are not being run in the real interest of the public. The Delhi Congress even filed a complaint with the Central Vigilance Commissioner.
Cracks in the clinics
The Aam Aadmi Party government has been running the clinics as a pilot project for six months, during which time it has been promoting the achievement in advertisements. The project has generally received positive reviews in the media. Even the Washington Post had good things to say about mohalla clinics, Chief Minister Arvind Kejriwal pointed out. Taking cue from the initiative, the Karnataka government is reportedly planning to set up mohalla clinics across the state and has promised to start the first one in Kolar.
The Delhi Congress's critical survey has reiterated flaws in mohalla clinic strategy, many of which have been written about before. Experts point to the dangers of public-private partnerships, the model on which most clinics are run on rented premises and with private doctors.
The mohalla clinic enterprise also throws up risks of higher healthcare costs since doctors are not paid fixed salaries but per patient and so have incentives to charge more. There are also possible conflicts of interest if, as the Congress claims, clinic premises are owned by people close to Aam Aadmi Party members. Other criticisms of the system include the use of private doctors who work at the clinics for only fours hours in the morning and that the system is not equipped to scale up care during emergencies like the current spurt in chikungunya and dengue cases.
The Congress argues that the Aam Aadmi Party inherited a robust health system in the city complete with 95 hospitals, 1,389 dispensaries, 267 maternity homes, 973 polyclinics, and 16 medical colleges. Its grouse is that doctors from government dispensaries have been transferred to mohalla clinics – the Aam Aadmi Party's priority. The Kejriwal government has said that it wants to dismantle dispensaries, once the mohalla clinics start running well.
“While nobody will disagree that our primary healthcare is lacking, why don’t we strengthen our dispensaries?” asked Maken.
Even before the Congress launched this offensive against the mohalla clinics, the BJP-controlled Municipal Corporation of Delhi went after the initiative by threatening to remove the two roadside porta-cabins that also function as clinics, saying that they did not have requisite permissions. Delhi Health Minister Satyendra Jain claimed that temporary structures did not need permissions.
Politics and public health
As opposed to most governments in the country which run healthcare on skimpy budgets, the Aam Aadmi Party has made education and healthcare a priority. The Delhi government has allocated 16% of its total budget for health as compared to just about 1.5% in the union budget. This is still not the highest per capita public health expenditure in the country: as against Rs 2,600 per person in Delhi, Sikkim spends as much as Rs 4,090 per person.
Even as the Congress raises relevant issues about the need and efficacy of mohalla clinics, the Aam Aadmi Party government can be credited for bringing public healthcare to the forefront of state politics. How often do we see a political party feel threatened by a health policy that they feel the need to denounce it?
Many conditions at the mohalla clinics that the Congress is complaining about are commonplace at healthcare facilities across the country – dirty surroundings, people having to sit on the ground to wait their turn, doctors not displaying their qualifications and taking just two minutes to examine a patient.
If these complaints about mohalla clinics are true, it is an appalling state of affairs. But these very conditions have been routinely ignored in almost all other public healthcare facilities. In this case, it is heartening to see that rather than seeing it as the norm – a trap into which even reporters who cover health fall into – the Congress has felt compelled to point it.
Whether the Congress or the Aam Aadmi Party prevails in this battle, the people of Delhi could ultimately benefit from this much-needed spotlight on public healthcare.
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