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Are mohalla clinics an answer to Delhi's health problems?

However, the ground reality presents a starkly different picture. This multiplicity of health schemes not only duplicates work, but allows ever-widening gaps that lets a majority of the poor, invisibilised populace fall through them.

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Being the national capital of the country, and a sprawling metropolis to boot, New Delhi should ideally be an example of smooth functioning, inclusive and comprehensive public health care for the country. On paper, it would seem so, with 17 different agencies operating health care infrastructure for various demographics, including the country's premier medical colleges and hospitals.

However, the ground reality presents a starkly different picture. This multiplicity of health schemes not only duplicates work, but allows ever-widening gaps that lets a majority of the poor, invisibilised populace fall through them.

In this context, in July, the Aam Aadmi Party-led Delhi government gave the city's health care an ostensible boost by opening a mohalla clinic in a jhuggi jhopri colony in north west Delhi, the first of a thousand such clinics; a pet project of the government. This re-ignited the debate on how public money is spent on health in a disjointed manner, and whether the city really needs another line of primary health centres. Are several agencies working without coordination not wasting money, and should all this effort of finances and labour not be more streamlined? Though the Delhi government has allocated a generous and much-needed sum of Rs 4000 crore for health, unlike the central government which slashed its health budget this year, there are concerns as to how this money is spent.

The National Human Rights Commission sent a notice to the government, on 5 August, asking the question on everyone's mind; before the government rolls out 1000 new clinic as primary health centres, what happens to the existing near 228 Delhi government dispensaries?

Delhi has the Central Government Health Schemes, Delhi Government Employees Health Scheme, MCD dispensaries, polyclinics and hospitals divided between the north, south and east corporation, ESI, Railways schemes, Cantonment area medical outlets, Delhi Fire Service, to name just a few. Despite a surfeit of schemes and dispensaries, its primary health level is crumbling, its secondary is non-existent and its tertiary severely overburdened.

Speaking informally, officials in the Union health ministry and the MCD say that this multiplicity doesn't work, efforts are far too scattered and lack inter-agency coordination. It would be best if all medical centres in the city were unified under the state government.

MCD officials are not sold on the idea of mohalla clinics, as they question how enough doctors and qualified help staff will be hired, and whether it is not a better idea to channel expenditure into strengthening existing facilities. One senior health expert in the MCD said that Delhi needs focus on tertiary care, on hiring specialists, on increasing beds and machinery, on enlarging the capacities of ICUs.

It is clear that hospitals, 39 of which are run by the state, and existing infrastructure is massively overburdened. "Even in CGHS, the lowest ranking government employee is fairly well off," said an officer in the central health ministry, "we need to cover those who cannot afford health care."

A senior MCD officer said that they had land, existing infrastructure and manpower but lacked money to run it all efficiently. They admit to lack of beds, fewer medicines, defunct machines. "We would be happy to work with the state government, as they have the money and we have the means," the officer said, adding that in north corporation alone the annual health expenditure was Rs 560 crore, which the MCD could not afford.

These problems are common to most hospitals. Doctors from the Federation of Resident Doctors' Association, who recently went on strike, say they don't have life saving drugs on hospital premises to give to patients.

"We cannot refuse anyone help," said the MCD official, "we take in numbers we cannot handle. Procurement processes for medicines and equipment are tedious and take very long." Again, this systemic problem can be seen in all government hospitals.

State health minister Satyendra Jain however, refused to show any enthusiasm for the prospect of such unification. "We'll unify, you can go tell them," he told dna. "Where should we raise such a proposal? The Centre will say we're fighting with them yet again," he added referring to the current animosity between the state and centre.

Jain also extended his suspicion to NHRC too. "Why have they issued a notice for mohalla clinics? Why are they not happy we're working for the public? They've never issued such notices before," he said defensively, even though NHRC regularly hauls up the state and Union ministries. An unanswered NHRC notice from last year questioned the Delhi government about two super speciality hospitals built a decade ago, lying unused. Jain's only reply is that they will soon be operational.

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