‘We are down to borrowing medicines’: Mohalla clinics, once AAP govt’s crown jewel, are running out of essential drugs

The injection is one of many essential drugs meant to be provided by the Delhi government’s central procurement agency (CPA) to different hospitals, mohalla clinics and dispensaries.

Except, for months now, this has not happened.

The Indian Express visited three government hospitals and six mohalla clinics in Southeast, East and West districts and found a shortage of essential drugs — meant to be available for free to patients — across the board.

The reason: Non-payment of vendors and a change in tender conditions, as a result of which two-thirds of the companies didn’t participate in the tender process this financial year. To put the crisis in context, only Rs 5 crore has been spent to procure medicines from the essential drug list (EDL) this year — a far cry from Rs 164 crore in the financial year 2023-24 and Rs 247 crore the previous year.

While larger hospitals are navigating the crisis by procuring the drugs from local vendors, albeit at a higher cost, mohalla clinics and smaller hospitals are faced with a far more dire situation. Officials estimate that even if measures to address the issue are taken now, it will take six months for the situation to normalise.

On the ground, desperation

At a mohalla clinic in a JJ cluster in Southeast Delhi, patients lined up to meet doctors and collect medicines. Many left not with the drugs they needed, but with white chits scribbled with the names of the medicines.

Poonam Devi, a resident of Molarband and a daily wager, had come to the clinic for severe leg pain and itching. She said the doctor told her to buy the medicine from outside. “Mohalla clinics are a boon for poor people like us. But if medicines are out of stock here, we’ll just not buy them since they’re expensive,” she said.

(Left) Patients at IHBAS. (Express Photo by Amit Mehra). (Right) An empty mohalla clinic in Geeta Colony (Express Photo by Tashi Tobgyal)

The doctor here attends to around 150 patients a day. “Since we can’t write ‘out of stock’ on their prescription, we are just verbally informing them or giving them chits to get the particular medicine from outside,” she said.

“We’re down to borrowing medicines from each other. We tell colleagues about our requirements on WhatsApp groups and share what we have,” she added.

This also played out at a mohalla clinic located in a slum in West Delhi, where a doctor anxiously typed on her phone. She was sending a message to a WhatsApp group that has Chief District Medical Officers (CDMOs) and doctors of other mohalla clinics about the dearth of medicines for treating diabetes, blood pressure, and other serious conditions.

The capital has a total of 533 mohalla clinics — once considered a crown jewel in the Aam Aadmi Party’s healthcare portfolio — and 30 Delhi government-run hospitals.

In Southeast Delhi’s Govindpuri, the clinic had been shut for the day, with locals saying the doctors have not been coming regularly ever since medicines ran out.

At a mohalla clinic in Geeta Colony in East Delhi, two pharmacists sat inside. “Medicines are not available, so most patients have stopped coming,” said one.

The medicines range from those prescribed for pain relief, scabies, skin infection, inflammation, and blood pressure to diabetes.

This is evident at a pharmacy across the road from IHBAS, where relatives of several patients gathered and paid out of their own pocket. (Express photo)

At hospitals under the Delhi government, too, the situation is grim.

At the Institute of Human Behaviour and Allied Sciences (IHBAS), the father of a 22-year-old undergoing treatment for schizophrenia has been struggling to get medicines for six months.

With no medicines for Parkinson’s disease, seizures and anxiety, panic disorder and epilepsy either, patients have to purchase them from outside.

This is evident at a pharmacy across the road from IHBAS, where relatives of several patients gathered and paid out of their own pocket. Jatin, a pharmacy store owner, said: “Andar almost sab dawai khatam hai (almost every medicine is over at the hospital).”

At Aruna Asaf Ali Hospital in North Delhi, medicines to treat haemorrhoids, seizures, thyroid, gout and kidney stones, fungal infections, pain relief, allergic rhinitis, nerve pain, acidity, depression and bacterial infections are in short supply.

What went wrong?

Like many other unresolved issues in the Capital, this too is mired in the government-bureaucracy tussle.

In July, Delhi Health Minister Saurabh Bharadwaj held a meeting where he suggested CDMOs were partly to blame. “… availability in terms of EDL being projected to the government is misleading because, in reality, CDMOs are not distributing available medicines to mohalla clinics. Therefore, even though some medicines are shown as available at the district level in its store… those medicines are not available at the mohalla clinic in reality,” he alleged.

He also wrote to then Chief Secretary Naresh Kumar: “It is the duty of Secretary (Health) and CPA officers, especially the Directorate General of Health Services, to ensure medicines are procured through CPA. In case medicines are not available through CPA, alternate mechanisms should be used to ensure medicines are available at all mohalla clinics.”

He alleged though CDMOs have been demanding medicines for months, CPA has not placed orders. “They selectively ordered only 5-10% of the type of medicines. The order which had to be placed in March for the first quarter was placed in July, that too for 50%… of medicines demanded by CDMOs,” he claimed.

But health department officials pointed to other lapses.

The Indian Express had earlier reported how drug suppliers had not received payment for medicines worth Rs 90 crore from the CPA for over six months. “The dues have now reached Rs 110 crore,” said a medicine supplier. On August 14, a group of suppliers wrote to Bharadwaj, stating they had not been paid dues since September 2023.

A senior official said that not only was payment delayed, but only around 100 suppliers bid for the procurement tender floated in April, as compared to over 300 the previous time. “Out of these, only 10 bidders qualified, compared to around 175-200 in previous tenders. Out of the essential drug list, of 1,100 medicines, tenders were passed for only 54 drugs for procurement,” he said.

Recently, a pre-bidding meeting was conducted with the vendors in the hopes of resolving the crisis. However, officials say that even if a tender is floated today, it will take six months to procure the medicines.

Officials also said that after the tender process was changed by former Chief Secretary Naresh Kumar, only companies with a turnover of over Rs 150 crore annually are now eligible to participate in the bidding. This amount was Rs 18 crore till last year.

Sources said manufacturers of generic medicine are diverse, ranging from startups to MSMEs and larger firms. Common medicines or fast-moving items are generally manufactured by smaller firms, having a low turnover. Bigger firms make specialised medicines such as cardiovascular and anti-cancer drugs and antibiotics. “90% of our health facility depends on common medicines generally manufactured by smaller firms. Hence, suddenly increasing the turnover from Rs 18 crore to Rs 150 crore is restrictive,” said an official in the Delhi government.

In September, a review meeting of health department officials, the minister and L-G was held where the issue was discussed. Subsequently, the EDL has been finalised and tenders floated. They are yet to be awarded.