Booster shot: A look at Delhi government’s healthcare reforms ahead of Assembly pollshttps://indianexpress.com/article/cities/delhi/delhi-aap-government-health-facility-reforms-hospitals-5957197/

Booster shot: A look at Delhi government’s healthcare reforms ahead of Assembly polls

With three new hospitals, the Delhi government hopes to strengthen healthcare infrastructure that is currently stretched thin. But with several projects already delayed, the road ahead remains steep. The Indian Express reports

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Construction underway at Indira Gandhi government hospital in Dwarka’s Sector 9. According to officials, the hospital will begin operations in March next year. (Express Photo: Abhinav Saha)

Bijli-paani, education and health. Reforms in these four sectors — the mainstay of Aam Aadmi Party’s politics — have regained focus as the capital nears Assembly polls scheduled for early next year. In the last two months alone, the AAP government has announced free power for practically half the city, water bill waivers, and free travel for women on public transport. In schools, the entrepreneurship curriculum has been introduced to see students become ‘job creators’.

But it is perhaps in healthcare where the Delhi government’s task remains most cumbersome. In its annual budget, the Delhi government allocated a large chunk towards the sector. Add to this several patient-friendly schemes — free tests at private labs, referrals to private hospitals and bearing the cost of treatment of victims of road accidents and acid attacks — and it’s clear that affordable healthcare remains a priority. But progress in infrastructure development has been slow.

A department-wise review of projects undertaken in February this year suggests that the task is cut out for the government, with 31 out of 55 Health Department projects pending at the time. The report, presented to Deputy Chief Minister Manish Sisodia, highlights pending projects including the construction and expansion of hospitals worth Rs 1,471.5 crore.

“Education and health are sectors that directly concern the general public. The work in the education sector picked up pace on time but several projects in the health department are lagging — administrative approval on every scheme is mostly delaying work. Projects announced by the government are patient-friendly and will change the face of healthcare facilities in Delhi,” emphasised a senior Delhi government official.

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In this year’s budget, Sisodia said the government has allocated 14% of the total budget to medical and public health. A total outlay of Rs 7,485 crore has been earmarked in the sector for 2019-20. This includes revenue budget of Rs 6,462 crore and capital budget of Rs 1,023 crore. An amount of Rs 3,737 crore has been apportioned for implementation of various schemes, programmes and projects under the health sector. The Indian Express looked at major projects where this money is being put to use.

Upcoming projects

The nearest hospital for residents of Burari in North Delhi is the MCD-run Hindu Rao, which is almost 15 km away from the residential colony. Recalling a personal crisis, Shyam Singh (65), who lives in Burari’s Kaushik Enclave, said: “My brother met with an accident while he was coming back from work. He was bleeding profusely and it took us almost an hour to reach Hindu Rao. Every resident in our area has faced this problem. Those who cannot afford treatment at private hospitals only have Hindu Rao as an option.”

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The under-construction government hospital in Burari (Express Photo: Abhinav Saha)

An 800-bed multi-speciality government hospital coming up in the area promises to help. The hospital in Burari, originally proposed to have 200 beds, was upgraded by the AAP government and will have speciality departments of gynaecology, orthopaedics, cardiology, neurology and paediatrics. It is expected to be functional by November 2019.

With a multi-level parking, space for patients’ attendants to stay, and state-of-the-art infrastructure, health officials say the hospital will be able to cater to around 1,500 patients on a daily basis.

“Almost 90% of the work on the hospital has been completed. The hiring process of doctors and nursing staff is in progress. The hospital will come as a relief to residents of North Delhi who have to travel far to avail facilities,” said an official from the Public Works Department (PWD). The building is complete and engineers are giving final touches.

Similarly, work on the construction of a 600-bed hospital at Ambedkar Nagar and another multi-speciality hospital with 1,241 beds in Dwarka has started, and both are expected to start functioning soon, officials said.

Residents, though, are cautiously optimistic. “A well-furnished hospital building is of little use if there are no facilities available. There are many government hospitals running without doctors, proper equipment and ventilators,” said Krishan Rao, a resident in Dwarka Sector 9.

This rings true at the two multi-speciality hospitals built by the government, which have been struggling to fill posts of doctors and paramedical staff. Rajiv Gandhi Super Speciality Hospital in Timarpur and Janakpuri Super Speciality Hospital both have world-class infrastructure, but little facilities to offer to patients.

“We have been improving the number of doctors and facilities in our institute. We are treating 1,500-2,000 patients in the OPD on a regular basis. We have added 120 beds to the existing 60. Other facilities, including CT scan, digital radiography and respiratory endoscopy unit, are also functional,” Dr Chhavi Gupta, deputy medical superintendent of the Rajiv Gandhi Super Speciality Hospital, told The Indian Express.

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The facility at Ambedkar Nagar. (Express Photo: Abhinav Saha)

A total of 394 beds have been added to 38 of its hospitals over the past three years, an answer submitted in the Delhi Assembly last week shows. In response to a question in the Assembly, the Department of Health informed that there were 10,959 beds in 2014-2015 and the number rose to 11,353 in 2017-2018. An outlay of Rs 588 crore has also been proposed for construction of new hospitals and remodelling of existing Delhi government hospitals.

“There is a dire need to start more government hospitals and increase the number of beds. But another factor to look at is the existing set up. Many existing hospitals are still struggling hard to meet the patient’s requirements. There aren’t enough technicians or doctors. It would have been better if the government focused on improving the old hospitals before constructing the new ones,” added another official.

Tough targets

Among this government’s most ambitious initiatives to change the face of primary healthcare was setting up of Aam Aadmi Mohalla Clinics (AAMC). The project started in 2015, and by December 2016, a total of 106 clinics had been established across all 11 districts. Three years down the line, the city has 195 such facilities against an initial target of 1,000.

“We are not just doctors but a community of people. We are involved in people’s daily lives,” said Dr Alka Chaudhary, while examining a seven-year-old girl who has been suffering from high fever at the government’s first clinic in Peeragarhi.

The government had, in 2016, announced it would build 1,000 such clinics in Delhi. But the process soon hit a roadblock after civic agencies cited issues such as unavailability of land, blockage of water pipelines and no power supply. Left with little options, the government has now reached out to the general public with a request to provide rented accommodation to set up the clinics. The rent, officials said, will be up to Rs 20,000 a month.

“We have received around 650 applications from different areas. We tried getting the land from agencies but it was an uphill task. The work on shortlisting the location has begun. The rented areas will not require much renovation work so the facilities will start immediately,” said Shaleen Mitra, officer on special duty to the Delhi Health Minister.

An outcome budget report, though, prepared by the government stated that the number of people visiting these clinics has reduced drastically. In its previous year’s budget report, the government had said around 80 lakh people availed services in 164 mohalla clinics. However, the number came down to 40 lakhs this year, as per the current budget report.

‘Administrative delays’

Talking to The Indian Express in January, Delhi Health Minister Satyendar Jain had said that important health schemes proposed by the AAP government in the last few years have not been able to see the light of day due to the administrative delays. The schemes, such as setting up guidelines for regulation of private hospitals, introduction of health cards for Delhi residents, and establishing a Delhi Healthcare Corporation, are yet to take off.

Jain had attributed the delays to the bureaucracy, claiming that files are lying pending with officers. “Whatever initiative we take, it is objected to by some officer at every level. There are many projects which were proposed in 2016 and they are not yet approved by the Lieutenant-Governor. The files are directed from one department to another, hence pushing the proposal backward,” Jain had claimed.

For instance, in October last year, Jain had proposed to Chief Minister Arvind Kejriwal restructuring and taking over the council of six superspeciality autonomous hospitals — Institute of Liver and Biliary Sciences (ILBS), the Delhi State Cancer Institute, the Rajiv Gandhi Super Speciality Hospital, Maulana Azad Institute of Dental Sciences, Chacha Nehru Bal Chikitsalaya, and Janakpuri Super Speciality Hospital.

While the CM had approved the proposal, the decision has not been implemented so far. “The Cabinet has approved the restructuring of three hospitals but files are stuck with the officers,” claimed a senior Delhi government official.

But officers say issues such as multiplicity of agencies and the sheer number of projects to be executed are also reasons for delay. Senior officers working closely with the government on various projects claimed while a project is envisaged with a positive vision, the due course followed to implement the scheme is not taken into consideration at times.

“None of the projects announced over the last few years have been withdrawn, only the deadlines have been extended. And the onus of not meeting the deadline is not with a single department or an officer. The involvement of multiple agencies is one of the major reasons behind the failure. But, before announcing multiple projects, the government should focus on completing the previous one,” said a senior officer from the department of health.

Another senior health official added: “The responsibility of projects is frequently transferred from one officer to another. In many cases, the scheme is about to take off but the officer heading the project is changed and the department has to start everything from scratch. This leads to unnecessary delays.”

In the pipeline

Guidelines for private hospitals: A nine-member committee formed by the AAP government to monitor the functioning of private hospitals had, among other things, recommended capping prices of medicines at the MRP listed in the National List of Essential Medicines, 2015. The draft advisory, which was submitted to the DGHS, is being revised again.

Rogi Kalyan Samiti: Delhi government decided to set up ‘Rogi Kalyan Samitis’(RKS) in each Assembly constituency and ‘Jan Swasthya Samitis’ in state-run dispensaries, polyclinics and mohalla clinics. The outcome budget report prepared by the government stated that not a single RKS has been set up in any constituency so far. The budget for the project is Rs 50 crore.

Health cards: The government had announced Aam Aadmi health cards in February 2018 to facilitate healthcare services for 1.8 crore residents of Delhi. It was expected to be launched in December 2018 but the department has once again initiated the work on the project.

Delhi Healthcare Corporation: The Department of Health and Family Welfare in 2016 established the Delhi Healthcare Corporation (DHC) – a public limited company under Companies Act 2013 – to provide clinical, non-clinical, administrative and support services to health facilities. These include procurement of drugs and equipment, setting up and running of laboratory services, management of outsourced services, smooth running of mohalla clinics and computerisation, among others. While the corporation was registered in 2016, it is yet to start operations.

So far, so good

The AAP government has provided free medicines to 18,95,715 people against the target of 18,33,860 people in its 26 hospitals. The number of patients in the In-Patient Department (IPD) per month in the government hospitals and those availing X-ray facilities have also gone up. While the services at government hospitals have improved, the eight autonomous institutes are yet to pick up the pace. In most of the cases, the government has addressed the patients’ complaints pertaining to various hospitals within 15 days.

As many as 1,116 patients have benefitted from the ‘Quality Healthcare for All’ scheme, which offers free surgeries to patients in 48 empanelled private hospitals. The scheme was launched in March 2017 and has borne around Rs 7 crore in the last two years as treatment cost for the patients.

To reach patients living in congested areas and JJ clusters in East Delhi (East, North East and Shahdara), Delhi Chief Minister Arvind Kejriwal and Health Minister Satyendar Jain had launched a fleet of 16 bike ambulances in Delhi. The project, which cost Rs 40 lakh, was approved by the Cabinet last year. Fitted with a portable oxygen cylinder, first aid kit, dressing materials, air-splints, GPS and a communication device, these ambulances will be monitored for a year.

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The government has also tied up with private centres to provide high-end diagnostics, such as MRI and PET-CT, that are not available at government hospitals. An outlay of Rs 49 crore has been proposed by the government on these schemes in the current budget 2019-2020.