The upcoming Delhi Legislative Assembly Elections have put the spotlight on healthcare in India, where an inadequate public system competes with unaffordable private players. Jisha Krishnan reviews the bold – and often controversial – healthcare policies of the Aam Aadmi Party, attempting to bridge the gap.

As India’s national capital braces itself for a fierce electoral battle on 8th February 2020, the conversations and debates in several newsrooms in the country are about healthcare. For, Delhi Chief Minister Arvind Kejriwal and Health Minister Satyendar Jain is busy inaugurating Mohalla clinics (primary healthcare centres) in a race against time.

When the Aam Aadmi Party (AAP) registered a landslide victory in the 2015 Assembly Polls in Delhi (winning 67 out of 70 seats), it had vowed to fulfil 70 promises – primarily in the areas of health, education and infrastructure – made in its election manifesto. In December 2019, AAP released a glorious report card of the work done by the Delhi government in five years, proclaiming it to be “the most honest government in the country”.

Did the government really deliver on all its healthcare promises? In a country where the majority of citizens are caught between an inadequate public healthcare system and an unaffordable private healthcare system, did the Delhi government succeed in bridging the gap? Here’s our critical review of AAP’s key healthcare policies:

Table of Contents

Brass tacks

At last count, the government had set up 450 Mohalla clinics and 25 polyclinics – most of it over the last couple of weeks. The ambitious target of 1,000 Mohalla clinics and 125 polyclinics is still a long way off.

Yet it’s the rare government that has steadily walked the talk in terms of budgetary allocation for healthcare. In 2015-16, AAP had allocated 9.5 per cent of the budgetary funds to health. In 2019-20, 14 per cent of the budget allocation (Rs 7,485 crore) is towards healthcare.

“On average, most state governments (in India) spend in the range of three to five per cent of their overall budgets on health. The priorities of the Delhi government are certainly made clear here with significant budget allocation – something that other state governments need to follow,” says Dr Sakthivel Selvaraj, Director – Health Economics, Financing and Policy, at the Public Health Foundation of India (PHFI).

“This is equally true for the central government,” he adds, “whose spending on health has been stagnant in terms of the overall budget in the recent past. Although in absolute amount, this has increased.”

Mohalla clinics

A flagship feature of the AAP government’s health policy, the Aam Aadmi Mohalla Clinic is essentially a neighbourhood facility that provides free primary healthcare to the national capital’s residents. As per official reports, the clinics have catered to more than two crore OPD patients and conducted 18 lakh tests till November 2019.

In a country where 62.58 per cent of the population has to foot their own healthcare expenses, Mohalla clinics have played a vital role in reducing the out-of-pocket expenditure. “However, beyond the 109 essential medicines and 212 diagnostic tests that are available for free, it is the easy access to quality healthcare that is the biggest USP,” says Sneha Gupta, a media professional from Delhi, who prefers the efficient Mohalla Clinic down the road to the “long waits for overpriced doctor consultations” at private hospitals.

Former UN secretary-general Kofi Annan and Ban Ki-Moon and ex-Norwegian premier Gro Harlem Brundtland, the former director-general of World Health Organisation, have also heaped praise on the government for its urban primary care initiative, after visiting the clinics.

When acquiring land for setting up more clinics turned out to be a persistent hurdle – courtesy nasty political differences between central and state governments – pre-engineered insulated movable structures made up the physical infrastructure of Mohalla clinics. In other cases, rented properties saved the day.

Quality healthcare for all

In 2017, the AAP government introduced a novel healthcare policy that allowed state-run hospitals to refer any patient waitlisted for a life-threatening surgery at the government hospital for more than 30 days to an empanelled private hospital, which in turn would treat the patient for free. The skeptics were certain that the scheme would fail. After all, you can’t expect the private hospitals to be accommodating just because the government hospitals are bursting at the seams!

Although the scheme – named Quality healthcare for all – has managed to stay afloat, its impact is hard to gauge in the absence of credible data. Also, the scheme applies only to permanent residents of the national capital, considerably limiting its reach. Apart from the general lack of awareness about the initiative and its benefits, there have been several issues related to delays in payment and patient management between the government and private healthcare players.

“Such Public-Private Partnerships are bound to fail, given that the public and private entities have their own visions and objectives to fulfil. An unholy alliance will end in disastrous consequences for the government health system and also accelerate overall healthcare expenses,” cautions Dr Selvaraj.

Great expectations

A September 2019 report, chalking out the Delhi government’s plans for the expansion of public health infrastructure, states that “in addition to the existing capacity of 11,353 beds in 38 Delhi government hospitals, a total capacity of 13,899 beds is being added. Three hospitals, with a capacity of approximately 2,800 beds, are set to open in the next six months.”

That’s nowhere close to AAP’s 2015 promise of increasing total bed strength in Delhi hospitals to 40,000. In fact, the government was confident that the numbers would be doubled within the first two years!

Nonetheless, the AAP government’s efforts to build a three-tier universal healthcare system in Delhi – comprising Mohalla clinics, polyclinics and hospitals – has certainly reduced the out-patient burden on government hospitals, granting them the uncommon opportunity to focus on quality in-patient care.

“The atmosphere at the public health centres in Delhi is definitely a lot more positive in the last five years. The patient experience has noticeably improved as has the morale of medical professionals at government hospitals,” says a Delhi-based journalist, who writes on healthcare for a daily newspaper.

The final analysis

Last year, the Delhi Chief Minister wrote to the Union Health Minister saying the Delhi government’s health scheme is “ten times bigger and comprehensive” than the Centre’s flagship Ayushman Bharat programme, touted as the world’s largest government-funded healthcare scheme.

Political rhetoric notwithstanding, the AAP government in Delhi has succeeded in putting the spotlight on healthcare in a country that is counted among the most underfunded healthcare systems in the world. The grand plan is for hospitals in the capital to become referral-only centres that specialise in surgeries and emergency cases, once the promised 1,000 Mohalla clinics and 125 polyclinics are set up.

However, with the government reducing the allocation for the development of Mohalla clinics and polyclinics from Rs 403 crore in 2018-2019 to Rs 375 crore in 2019-2020, there are serious questions about the achievability of the goal. Will it be a repeat of the government’s ineffective handling of the alarming pollution levels last year, prompting a Supreme Court-mandated panel to declare a public health emergency in the national capital? Can the party that caused one of the most momentous electoral upsets in Indian political history to manage to pull off its ambitious healthcare vision? Only time will tell.