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Delhi’s crumbling healthcare system: How AAP could improve it

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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 functioning of a society. Good health indices reflect the vigour and plethora of a society. Delhi is the capital of India and enjoys the status of a partial state: it is 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 1483 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 challenges in all areas, including healthcare delivery system.

In addition to a thriving private health sector, the health care services in Delhi are provided by central government and state government. Central governmental agencies like Ministry of Health and Family Welfare, ESI, CGHS (Central Government Health Scheme), and Railways operate hospitals and dispensaries. At the state level, the Health Ministry of National Capital Territory (NCT) of Delhi is a major player. The state government typically spends about 10 % of its 40 thousand crore annual budget on healthcare. It runs 39 hospitals and about 300 allopathic dispensaries. In addition, the state health department also 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 programs.

At the national level, government of India spends a measly 4 % of its budget on health. Given that, Delhi’s 10 % 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 over whelmed. 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 aburden on the state exchequer because of the gross under- utilization.

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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 poor and middle class people in Delhi. 300 odd allopathic dispensaries and 9 Primary Urban Health Centers (PUHCs) are clearly inadequate to meet the demand.  There is an immediate need to broadenprimary 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 wherecredentialed 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 numbers 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.

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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.

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 ministerand officials and improved oversight will surely bring more efficiency in the system.

Increasing bed capacity in Delhi hospitals is badly needed. Can we re-examinethe 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 malpractice. If the government acts as a facilitator, there will be an incentive for private medical sector to expand bringing down costs and better 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, amount of green space, level of sanitation, business environment and GDP were taken into consideration into this survey.  Frankfurt and London occupy the top two spots, Chicago standing at 19th position. The road to a better Delhi is not easy, but an integrated approach will alleviate some of the problems.

 

A MKThe author is a a practicing Neonatologist in Chicago. This op-ed is an exclusive article in his series Musings from Chicago. You can reach out to him at e-mail ID: pedia333@gmail.com and on Twitter @drMunishRaizada.

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Saw AAP MLAs Assaulting Chief Secretary, CM’s Advisor Tells Police

The AAP defended by stating that Jain had initially told police that he did not witness any assault and police has threatened Jain to change his statement

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The AAP had denied the charges of assault and said that the Chief Secretary was making allegations at the behest of the BJP. Wikimedia Commons

Delhi Chief Minister Arvind Kejriwal’s adviser V. K. Jain on Thursday told police that he saw AAP MLAs Amanatullah Khan and Prakash Jarwal “physically assaulting” Chief Secretary Anshu Prakash, according to Jain’s statement recorded by the Delhi Police.

The AAP defended by stating that Jain had initially told police that he did not witness any assault and police has threatened Jain to change his statement.

On Tuesday, the Chief Secretary had alleged that he was beaten up by the two AAP MLAs in the presence of Kejriwal at the Chief Minister’s residence on Monday night, where he had been called for an emergency meeting.

ALSO READ: The assault on Chief Secretary exposes the double standards of AAP government

Police later arrested Khan and Jarwal and they were sent to judicial custody till Thursday.

According to the Chief Secretary, the Chief Minister’s adviser had called him over the phone and asked him to come to the Chief Minister’s residence for the meeting and Jain was also present there.

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According to the statement, Jain also saw that the Chief Secretary’s spectacles had fallen to the ground and the Chief Secretary picked them up and left the room. Wikimedia Commons

On Thursday, the Delhi Police submitted Jain’s statement at a city court, which said that Jain had gone to the washroom during the meeting and as he came out he saw the two AAP MLAs “physically assaulting” the Chief Secretary.

The statement was recorded under Section 161 of the CrPC, which means that it was recorded in front of the police and not a magistrate.

Sources told IANS that Jain later recorded his statement in front of a magistrate under section 164 of the CrPC.

“The statement under section 164 was later recorded with the magistrate in front a camera, without the presence of police. In that statement also he (Jain) has said that he saw the two MLAs physically assaulting the Chief Secretary,” a police officer privy to the case told IANS.

The officer said that the statement under section 164 has also been submitted to the court.

Jain was first questioned on Wednesday morning and then again on Thursday and his statement was recorded on Thursday.

The change in Jain’s statement that the AAP was referring to was from a “question and answer” with Jain recorded by police after questioning him on Wednesday.

According to a copy of Wednesday’s “question and answer” recorded by police, when asked whether Jain saw the Chief Secretary being manhandled, he replied that he had gone to the washroom in between the meeting and he could not say what happened during that time.

“By putting pressure on him (Jain) throughout the day (Thursday) and by threatening him, police has forced him to change his statement,” AAP MP Sanjay Singh told the media here on Thursday.

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Singh said that the whole issue was a conspiracy to “bring down the Delhi government” and to “defame the AAP”. Wikimedia Commons

 

“How is it that the same Jain who emphatically said yesterday that he witnessed no assault during the entire time that he was present there has now claimed otherwise?” he asked.

Singh said that AAP MLAs were being arrested over an alleged assault of which there was no proof.

“But on the other hand, despite there being video footage of officials assaulting Delhi Cabinet Minister Imran Hussain, there is no action taken against the guilty by the Delhi Police,” the AAP MP said.

The court on Thursday sent the two AAP MLAs, arrested on charges of assaulting the Chief Secretary, to judicial custody for 14 days.

ALSO READ: Delhi Chief Secretary row: AAP MLA arrested

Orders on the bail pleas of the two AAP MLAs and also on their police custody will be pronounced on Friday.

Meanwhile, scores of Delhi government employees across the city observed a five-minute silence outside their respective offices as a protest against the alleged assault on the Chief Secretary.

The IAS Association said that officers would continue the protest every day, till steps are taken to “ensure safety and dignity” of government staff in the city.

The AAP also hit out at Lt Governor Anil Baijal by stating that he was “working as a BJP agent” and demanded action against those involved in “manhandling and beating up” Hussain and his aide at the Delhi Secretariat on Tuesday. (IANS)