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

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.

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.

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 49^th 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 19^th position. The road to a better Delhi is not easy, but an integrated approach will alleviate some of the problems.

The 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.