October 6, 2022

Good morning. In today’s either/view, we discuss whether the mohalla clinics started by Aam Aadmi Party have been a success in Delhi. We also look at the delay in conducting civic polls in Bihar, among other news.

📰 FEATURE STORY

Mohalla Clinics – Has the AAP’s initiative been a success?

First opened in West Delhi in 2015, ‘Mohalla clinics’ are a part of the initiative of the Delhi state government to provide low-cost high-quality healthcare services to the urban poor population. A by-product of the Delhi assembly election results, have these institutions been a success?

Context

The primary healthcare clinics, called Aam Aadmi Mohalla Clinics, provide free consultations, medication, and 200 free diagnostic tests under one roof. The initiative has spread to 11 districts of the capital with over 500 functioning clinics that meet the day-to-day healthcare needs of the poor. Each clinic is staffed with a doctor on call, a nurse, a multi-task worker and a lab technician.

A first-of-its-kind, the Mohalla clinic initiative under Arvind Kejriwal’s government has acquired international acclaim and many states have expressed their intention to emulate the same with Hyderabad launching its Basti Dawakhanas in 2018. The earlier norm for public healthcare was established in 2007 with the Arogyasri scheme started in Andhra Pradesh where government health insurance covered inpatient hospitalization needs. However, Mohalla clinics target even non-critical healthcare needs.

The move, however, was taken with a pinch of salt by critics as they pointed out the timing of the implementation of the initiative. The majority of the clinics were established just ahead of elections; 154 in January 2020 and 100 in the last quarter of 2019. A public health expert examining the government’s goal to open 1,000 clinics stated that the move was aimed at garnering votes as Delhi does not require so many clinics.

VIEW: Mohalla clinics have been successful

The concept of a free-of-cost primary healthcare clinic for the urban poor population is a revolutionary scheme to promote the overall healthcare system in the country. During the dengue and chikungunya outbreaks in Delhi between September and October 2016, the mohalla clinics became a critical passage point for patients to get examined and complete lab tests.

Even during the Covid-19 pandemic, these clinics played a vital role in ensuring healthcare services at a time when big institutions and hospitals refused outpatient consulting services. Despite a lack of safety equipment such as personal protective equipment (PPE), limited resources and salary payment delays, mohalla clinics continued to provide primary healthcare services.

A survey conducted by research organisation IDinsight revealed that 74% of people who use the clinics are likely to return to the facility for medical treatment. 97% of the respondents stated that treatment at mohalla clinics was at par or better than other facilities. With over 300 mohalla clinics in Delhi, poor people need not travel all the way to government hospitals due to minor illnesses for free healthcare facilities.

Additionally, Harvard University signed a memorandum of understanding (MoU) with the Delhi government in 2019 to allow the prestigious institution to study the success stories of mohalla clinics. This initiative is also gaining traction in different parts of the country as Punjab signed a knowledge-sharing agreement with the AAP government in Delhi in April this year to replicate the mohalla clinic in the state.

COUNTERVIEW: Mohalla clinics have not been successful

While there is no doubt that the mohalla clinic is an exemplary initiative for healthcare services, we cannot turn a blind eye to its substantial shortcomings. The survey by IDinsights also highlighted that 40% of the respondents were unaware of the existence of these clinics. 40% of the participants also suggested improvements in terms of availability of staff, clinical infrastructure and availability of medicines.

The Delhi government aims to open 1,000 mohalla clinics with one doctor each. This leads to a higher workload for doctors as more poor patients will approach these clinics. This coupled with a shortage of staff affects the quality of service provided. One of the doctors working at a mohalla clinic in Usmanpur highlighted this while pointing out that the clinic has only four staff members including the doctor.

Additionally, due to being located in slums and jhuggi clusters, the condition of these clinics is extremely unhygienic. Under such conditions, it is challenging for healthcare professionals to provide health facilities and run awareness campaigns. The clinics also mostly comprise a one-room rented facility or porta cabin. Officials claim that the lack of space makes it difficult to conduct tasks like blood sampling, blood testing and immunisation.

As of July 2019, a report revealed that 41% of Delhi residents still rely on private healthcare services. This could be due to the fact that the mohalla clinics are designed to provide curative and diagnostic services only. There have been complaints of very little preventative care and a lack of immunisation and antenatal services.

Reference Links:

What ails Delhi’s Mohalla clinics (The New Indian Express)
Process for setting up ‘mohalla clinics’ in Punjab starts (Times of India)
Supporting the Government of Delhi to improve primary healthcare via the mohalla clinic programme (IDinsight)
Delhi loves its Mohalla Clinics, but can they really improve public healthcare? (Citizen Matters)
The success of mohalla clinics (The Telegraph)
Going places: Harvard likely to study success story of Delhi’s mohalla clinics (Times of India)
Delhi’s Mohalla clinics: The first line of defence (Observer Research Foundation)
Aam Aadmi Mohalla Clinics: What Has Worked, What Hasn’t (IndiaSpend)

What’s your opinion on this?
(Only subscribers can participate in polls)

a) Mohalla clinics have been successful in Delhi.

b) Mohalla clinics have not been successful in Delhi.

🕵️ BEYOND ECHO CHAMBERS

For the Right:

Dear Indian Friends, You Are On The Wrong Side Of History — A Letter From A Russian-Speaking Ukrainian

For the Left:

Mission Karmayogi: Reimagining The Civil Servant

🇮🇳 STATE OF THE STATES

Norms for tractor trolleys (Uttar Pradesh) – Despite the high frequency of deaths and mishaps on roads involving tractor trolleys, the state transport department hasn’t yet provided the guidelines and design norms to register domestically-manufactured trailers. One official said this is the responsibility of the transport commissioner per the UP Motor Vehicles Rules of 1998. Most of these trolleys are attached to tractors illegally and aren’t registered with the RTO.

Why it matters: These tractors are used to transport passengers and other commercial purposes in violation of the rules. Data from the transport department shows only 583 are registered for commercial purposes despite the state having more than 10,000. In less than two weeks, there have been 37 deaths in road accidents involving tractor trolleys. Section 172 of the UP Motor Vehicles Rules of 1998 states these trolleys can’t be used as a transport vehicle.

State police deny PFI links (Kerala) – The Kerala Police denied that its officials had any links with the now-banned Popular Front of India (PFI). It responded to reports that the National Investigation Agency (NIA) handed over a list of 873 cops who are suspected of being associated with PFI. Calling the reports baseless, VP Pramod Kumar of the Police media centre said no such list was given. There were also allegations that these policemen leaked information to the PFI.

Why it matters: Last week, investigative agencies conducted nationwide raids on the PFI, which the government has now banned and deemed a terrorist outfit. During the raids, many PFI leaders were arrested. In response, the group called for a country-wide bandh which later saw violence erupt. The state police arrested 2,500 PFI activists and registered 350 cases in connection with the violence.

Civic polls delayed (Bihar) – The civic polls in the state have been deferred. The Patna High Court declared the reservations for backward classes in the polls illegal. It said they don’t satisfy two of the three conditions set by the Supreme Court to determine a group’s political backwardness. The State election commission issued a notice to postpone the elections scheduled for October 10 and 20. The court said the elections can go ahead only by re-notifying the reserved seats as a general category.

Why it matters: The petitioners in the case argued that the state government failed to collect any data to find out the political backwardness of a group. The state election commission was criticised for not functioning independently. The verdict led to a row between Chief Minister Nitish Kumar and the BJP.

Defunct CCTVs (Goa) – With rising crimes like burglaries and kidnapping attempts in broad daylight, state authorities don’t seem to have vigilance and surveillance as a top priority. Most of the CCTVs across the state aren’t functioning. In some places, there aren’t any. Police Inspector Gautam Salunke said that currently there are 23 CCTVs at 11 locations, but none are functional. He said the local bodies have been made aware of the issue.

Why it matters: In 2020, the murder of a goldsmith in the streets of Margoa was a wake-up call. At the time, the police had to go from one shop to another to get proper footage of the attack from privately owned cameras. A proposal by the late Rajya Sabha MP Shantaram Naik to install CCTVs at Fatorda never materialised. While some have cited a lack of funds, others aren’t convinced since CCTVs were installed under the Smart City project.

Police stations on the border (Manipur) – The state government has begun building 34 police stations along the India-Myanmar border to check illegal immigration and drug trafficking. Chief Minister N Biren Singh said the stations will be constructed from Behiang to Jessami along the border. To deal with the influx of migrants, the state adopted a resolution in August to enforce the National Register of Citizens to help identify and weed out illegal foreigners.

Why it matters: Five of the state’s districts, Chandel, Tengnoupal, Kamjong, Ukhrul, and Churachandpur, share a border with Myanmar. About 5.3 km of the 398 km-plus border with Myanmar is fenced. Since the coup in Myanmar last year, there has been a concern about the influx of people. The free movement regime allows people to enter up to 16 km on either side of the border without documents. This has added to the state’s worry.

🔢 KEY NUMBER

86% – The percentage of global CEOs surveyed by KMPG that believe there’ll be a recession in the coming year. As part of KPMG’s 2022 CEO Outlook, three-quarters of the 86% said they’ve already taken precautionary steps.