Two years of AAP govt: Are mohalla clinics a game changer in Delhi?

delhi

Updated: Feb 13, 2017 09:19 IST

Over five months, 110 mohalla clinics have treated 8 lakh patients, as per the government data. The AAP government showcased this as a path breaking achievement and received international acclaim. However, insiders believe that the project is still in its nascent stage and is far from being a game changer for health sector.

World leaders like former UN secretary general Kofi Annan and former WHO director general Dr Gro Harlem Brundtland praised the project for aiming to provide free public health care and indicated the need to scale up the project as well as improve its management. “The project could be a model for all Indian states embarking on the UHC (Universal Health Care) journeys,” read the letter to Delhi chief minister Arvind Kejriwal by Annan in his capacity as chair of The Elders, an organisation of independent global leaders founded by Nelson Mandela.

The government had planned to set up 1,000 mohalla clinics for consultation, medicines and tests free of cost by the end of 2016. This deadline has been extended to March 2017 but it is unlikely that the government will be able to meet it. With, only around 110 mohalla clinics functional, the AAP government has sought to take refuge in its infamous tussle with the lieutenant governor and Centre.

“The government had said that the project will reduce over-crowding in tertiary care centres like ours. However, the impact cannot be felt just with the 100 clinics. Once the project is complete we will be able to see the results,” said Punita Mahajan, medical director of Baba Saheb Ambedkar hospital.

Doctors working with the project also point to some inconsistencies.

“Looking at just the model clinic is not enough. Apart from routine out-patient clinic, we provide immunisation to children, DOTS centre for TB treatment and counselling for male sterilisation but these services are not available in the other clinics,” said Dr Alka Choudhary, who is posted in Peera Garhi Mohalla Clinic. Also, all clinics are not able to provide the promised 212 tests; her clinic provides only 25 tests, she said.

Space constraint and slow technology also add to the woes of doctors. “Since the time the clinic has started, the number of people has kept on increasing, so much so, that there is no place for the patients to wait. Add to that the slow tabs and the numerous fields we have to fill in, the wait period just keeps on increasing,” said Dr Preeti Saxena from Pandav Nagar mohalla clinic.

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REPORT CARD Health goals elusive Mohalla clinics have established AAP government’s goal to provide universal healthcare, but institutional changes are yet to be seen A mohalla clinic at Peera Garhi camp in west Delhi near Paschim Vihar. (VIPIN KUMAR/HT) More money for public health Health sector received second highest budget allocation for both years of AAP in power In Delhi budget 2016-17, government allotted 16% of outlay — ₹5,259 crore — to health Traditionally, Delhi has highest public health spend in India as compared to other states — an average of 10.1% of total spending between 2010-11 and 2015-16 In its first year in power, the government fell short by ₹515 crore on health spend as compared to budget estimates Mohalla clinics Provide 110 essential drugs and 212 diagnostic tests 100 clinics have treated nearly 1.5 million people in 7 months FLIP SIDE: The promise of 1,000 Mohalla clinics by December 2016 has not been met. There are major inconsistencies in services and quality of care across the clinics. Home to hospital Government added 110 new ambulances to its existing fleet of 155 Free ambulance services for all emergencies, unlike before when CATS responded to only road traffic accidents and women in labour Nearly 600 ambulance dispatches everyday New ambulances are equipped with self-collapsible trolley stretchers, spine boards, scoop stretchers, automated external defibrillator (AED) and oxygen delivery system Online system for automatic dispatch of ambulances according to proximity Free medicines Delhi’s essential drug list to include 1,390 medicines, up from 406 in 2014 Only generic drugs prescribed from list of essential drugs Three months’ stock of medicines allowed to ensure no shortfall. Medical directors have the power to purchase medicines in small quantities to meet shortfall FLIP SIDE: Long queues and touts who provide ‘free’ medicines for a price at hospital pharmacies negate the benefits Free diagnostics Promise of free advanced diagnostics, including expensive tests like MRI, not met Only one MRI machine in Lok Nayak hospital shared by all Delhi government hospitals. Waiting period is two years. No bidders to run five MRI and 10 CT scan machines on PPP basis Tie-up with eight imaging centres for free diagnostics to patients below poverty line not enough to reduce wait period Bed Strength No increase in the bed strength in Delhi government hospitals Promise to add at least 10,000 hospital beds by end of 2017 not met Delhi has 2.71 beds for every 1,000 persons; WHO standard is 5 Plans to add 8,000 beds in 2018 at three new hospitals in Ambedkar Nagar, Dwarka and Burari and through the restructuring of 11 government hospitals

Read: Apathy, poor infrastructure haunt govt hospitals in state

The BJP has also flagged the lack of monitoring in the project that has allegedly resulted in doctors giving inflated numbers to get bigger pay checks as they get paid on per patient basis. “I know of clinics where people with chronic conditions like COPD, asthma, diabetes are called every other day to get their medicines. This is done to drive up the OPD numbers as they get paid ₹30 per patient,” said Dr Choudhary, who is a contractual doctor under NRHM and has been posted in the clinic.

“Initially, doctors inflating the numbers for more money was a concern for us too but we later realised that these clinics receive so many patients that the doctor can either treat them or sit and fill in records,” a Delhi government official said.