Healthcare Challenges for New Government in Delhi

Delhi health minister Satyender Jain

With the crowning of Aam Aadmi Party’s government in Delhi, there is a renewed interest in public as to how the party will bring about better governance and public good. After all, the expectations are high as Delhi voters catapulted the activist party into power with whopping 67 out of 70 seats, forcing Arvind Kejriwal to admit that it was a ‘scary mandate!’
Healthcare is an integral component of the healthy functioning of a society. Good health indices reflect the vigour and development of a society. Delhi is the capital of India and enjoys the status of a partial state being a union territory, but at the same time, has an elected legislative assembly. Thus, its administrative system is a mixed one, with some of the key portfolios lying with the Center. Spread over a tiny area of 1,483 square km, Delhi’s vast population of 1.7 crore makes it the most densely populated (population density more than 11,000 per square km) area in India. This poses huge challenges in all areas, including healthcare delivery system.
        In addition to a thriving private health sector, the health care services in Delhi are also provided by the central and state government. Some autonomous hospital being run on central government funds like All India Institute of Medical Sciences (a super multi-speciality hospital where 1.5 million outpatients visit in a year) and National Institute of Tuberculosis and Respiratory diseases, some directly run by it like Safdarjang Hospital (a huge 1600-bedded multi-speciality hospital), Dr Ram Manohar Lohia Hospital, Sucheta Kripalani Hospital etc. Central government agency ESI has its own hospitals and numerous dispensaries. The CGHS has similarly hundreds of dispensaries for government employees and Railways too operate its hospitals and dispensaries and also there are military hospitals.


At the national level, government of India spends a measly 4.1 percent of its budget on health. Given that, Delhi’s 10 percent looks healthier, but it still leaves a lot to be desired.
        At the state level, the health ministry of Delhi government is a major player. The state government typically spends about 10 percent of its Rs 37,000 crore annual budget on healthcare. It runs 39 hospitals and about 300 allopathic dispensaries. In addition, the state health department runs mobile dispensaries, school health scheme, Centralized Accident and Trauma Services (CATS); and its AYUSH department administers Ayurveda, Unani and Homeopathic dispensaries and hospitals. The department is also responsible for executing several public health programmes.
        At the national level, government of India spends a measly 4.1 percent of its budget on health. Given that, Delhi’s 10 percent looks healthier, but it still leaves a lot to be desired. Given Delhi’s burgeoning population, large clusters of slums (50 lakh population), the healthcare system remains overwhelmed. Visit any hospital in Delhi and you will see lack of resources, overcrowding, and lack of cleanliness. Poor political will, bureaucratic apathy and inertia have contributed to the sorry state of affairs. Many of the rural healthcare facilities are dysfunctional and a burden on the state exchequer because of the gross under-utilisation.
Delhi’s crumbling health care system needs overhaul and some out of the box ideas. While, increasing budgetary spending on health will definitely help, there could be several other ways to meet the need.                 Affordable primary healthcare access is a major challenge for the poor and middle class people in Delhi. Three hundred odd allopathic dispensaries and 9 Primary Urban Health Centers (PUHCs) are clearly inadequate to meet the demand. There is an immediate need to broaden primary health access points. Rather than opening up more dispensaries (thus, opening more avenues for leakage, corruption and inefficiency), we should look at alternative solutions. The existing government dispensaries can act as poly-clinics where credentialed private doctors can be allowed to come and provide healthcare at the affordable pre-determined prices or they can be reimbursed by the government on the basis of volume of patients seen. Similarly, it may be prudent to open up large number of government-approved primary level clinics owned/maintained and operated by independent healthcare providers. The patients can avail the health care from such avenues and the government would reimburse the bills to the doctors.
        The concept of electronic record keeping and biometrics—a common usage in western world—is non-existent in Delhi health system. An investment on this front will bring down the costs in long term and bring traction in the system.
Rather than opening up more dispensaries (thus, opening more avenues for leakage, corruption and inefficiency), we should look at alternative solutions. The existing government dispensaries can act as poly-clinics where credentialed private doctors can be allowed to come and provide healthcare at the affordable pre-determined prices or they can be reimbursed by the government on the basis of volume of patients seen.
         Unfortunately, the governmental systems in India are known for poor quality of services, sluggish pace, an attitude of indifference and inefficiency. Random checks by health minister and officials and improved oversight will surely bring more efficiency in the system.
        Increasing bed capacity in Delhi hospitals is badly needed. Can we re-examine the existing infrastructure and add more beds rather than necessarily opening up new hospitals? The private medical sector is an important asset for Indian healthcare delivery system. Delhi health ministry should have a collaborative approach towards private sector which will result in better coordination, and less malpractices. If the government acts as a facilitator, there will be an incentive for private medical sector to expand bringing down costs and improving services. Similarly, since AAP claims to be a doer and believes in beefing up systems, corporate social responsibility (CSR) is one area, where a pro-active health minister can bring in a lot of money. Delhi can also be developed as a hub of medical tourism. If we reflect upon why Thailand took over us in this field, answers would be apparent!
        Last, but not the least, increased focus on preventive aspect of healthcare will yield better result. More spending on maternal and child health (MCH) and senior citizens is needed.
        In a recent survey done by Arcadis, a Dutch design group, on most sustainable cities, Delhi comes at poor 49th out of a list of 50. The parameters like health indices, income equality, green spaces, sanitation, business environment and GDP were taken into consideration into this survey. Frankfurt and London occupy the top two spots, Chicago standing at the 19th position. The road to a better Delhi is not easy, but an integrated approach will alleviate some of the problems. (MKR)
(Note: The article was first published in the Lokayat magazine:April, 2015)