Delhi elections: The healthcare outcome

Delhi elections: A landslide victory for Kejriwal. But what’s next for healthcare?

The results of the Delhi elections suggest a landslide victory for the incumbent Aam Aadmi Party (AAP) government under Arvind Kejriwal, who seems poised to assume the office of the national capital’s Chief Minister for a third term. 

“The Aam Aadmi Party repeated its 2015 feat in Delhi as it reduced its closest rival – BJP – to single-digit seats in the seventy-member assembly,” NDTV reports. “The Arvind Kejriwal-led party is set to win 63 seats as counting of votes neared its end while the BJP…settled around seven seats after initial gains.” 

“May God give us more strength to serve people of Delhi,” Kejriwal announced to supporters. Prime Minister Narendra Modi, meanwhile, tweeted his congratulations to the AAP and to the Chief Minister. “Congratulations to AAP and Shri @ArvindKejriwal Ji for the victory in the Delhi Assembly Elections,” he said. “Wishing them the very best in fulfilling the aspirations of the people of Delhi.” 

Healthcare was one of the issues addressed by the Kejriwal administration during its term in office through its primary healthcare scheme, Mohalla Clinics. That initiative compared to the Centre’s flagship health insurance scheme Ayushman Bharat has been a bone of contention, in light of Kejriwal’s government’s refusal to implement Ayushman Bharat in the National Capital Region (NCR). In view of the results of the Delhi elections, there is an opportunity to review the Mohalla Clinics scheme; the progress made under the Kejriwal ministry so far; and what is there to be built upon heading in to the next administration. 

The future of healthcare in the NCR

Kejriwal drew attention to healthcare in his victory speech. “It’s not just my win,” he said. “This is a win for every family whose children are now getting good education in school, whose family members are getting good treatment in hospitals.” Going into the Delhi elections, the government was given a thumbs up by voters on its performance on healthcare. 

In a survey by the IANS-Neta App published ahead of the Delhi elections, eighty percent of respondents believe healthcare accessibility in Delhi has improved during the Kejriwal administration and 69 percent expressed satisfaction with Mohalla Clinics. However, their ostensible popularity notwithstanding, it cannot be argued that Mohalla Clinics have not faced issues since their launch in 2015. 

The three-tiered Mohalla Clinics network – consisting of primary health centres (the eponymous Mohalla Clinics), polyclinics, and public hospitals – marked an ambitious push to improve access to healthcare. Any manoeuvre in this direction is both admirable and ambitious – but the verdict is mixed when the discussion pivots to whether the vision behind Mohalla Clinics could be matched in practice. 

The issues with Mohalla Clinics

Going into the Delhi elections, multiple news reports analysed the performance of the Delhi government on health through the prism of Mohalla Clinics. Items of progress were identified, as were areas where the state government was significantly behind target. 

At the beginning of its term in office in 2015 (Kejriwal’s second chief ministry), the Delhi government announced its target of building 1,000 Mohalla Clinics in its five-year term. However, as of February 6th, 2020, the number of Clinics built numbered at 450 – the majority of which had been constructed in the months leading up to the Delhi elections. 152 Mohalla Clinics were built in January 2020 alone; the final quarter of 2019 accounted for 100 clinics. 

The reasons why the state government has been behind target are manifold. As cited in an HealthCheck report, “one public health expert who has studied Mohalla Clinics said the plan to open 1,000 such clinics by March 2020 was excessive and aimed at garnering votes, adding that Delhi does not need so many clinics.” 

Arguable overreach by the AAP in its campaign has coupled with logisticial issues – namely, as India Today reported in January, that it had been “bogged down by red tape in land acquisition” in efforts to build the clinics. Such issues have been raised by the Delhi government, which has alleged non-cooperation by the Delhi Development Authority and other central government authorities. The government has, in the past, gone so far as to petition the Delhi High Court over the issue. 

One issue linked to Mohalla Clinics by Firstpost has been overload from the citizenry. “Clinics probably never anticipated nor were designed to cater to a large number of patients,” the report suggested, citing “available figures” which suggest that “at least over 200 to 300 persons visit these clinics…daily.” The Mohalla Clinics and polyclinics “are functioning at only ten to fifteen percent capacity,” Firstpost goes on to write. 

Progress made in healthcare accessibility

These caveats aside, however, Mohalla Clinics has won praise. For one, despite overburdening issues, healthcare accessibility has improved thanks to the clinics. The reports in HealthCheck and Firstpost name examples of those who have availed healthcare services ranging from diagnostics to treatment thanks to Mohalla Clinics, that they either may not have been able to without them or would have incurred a substantial financial burden. 

Firstpost also reports that conditions in the 38 public hospitals operated by the Delhi government have improved in recent years and the scope of treatment packages freely available to Delhiites has expanded under the Delhi Arogya Kosh (DAK). “The state has made all medicines, tests and surgeries at these hospitals completely free,” Firstpost reports. “Further, if patients who are residents of Delhi are waitlisted for a life-threatening surgery at a Delhi government hospital for more than thirty days, the hospital refers the patient to any one of its 31 private centres and 57 empanelled private hospitals, which treats the patient for free within fifteen days. For the first time, even expensive tests like CT scans and MRIs are being conducted for free.” 

The ostensible successes of Mohalla Clinics have caught the eye of other states and union territories in India, including Jammu and Kashmir, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, and Telangana. The scheme has also captured international attention. 

What will the Delhi elections mean for Ayushman Bharat?

The pros and cons of Mohalla Clinics considered, the coming term in office for the Kejriwal government will see if these issues can be overcome. One issue of contention likely to remain significant in the public and political spheres is the tussle between the Delhi government and the Centre over their respective health models – Ayushman Bharat and Mohalla Clinics.

Delhi is one of a few states to have yet to implement Ayushman Bharat, or the Pradhan Mantri Jan Arogya Yojana (PMJAY). This move has been fiercely critiqued by the BJP, in particular Union Health Minister Dr Harsh Vardhan who has repeatedly urged the Delhi government to implement the initiative and has deemed Mohalla Clinics an “utter flop”, telling Kejriwal in mid-2019 that “all your fancy schemes, including the much-touted Universal Coverage Health Scheme, announced more than a year ago, are still lying on the drawing boards awaiting implementation even after four and a half years.”

Kejriwal has shown signs of softening his government’s stance on not implementing Ayushman Bharat in the past. However, with the Delhi elections having returned him to power, the future of Ayushman Bharat in the NCR seems unclear. 

Indeed, Mohalla Clinics are not perfect. As described in The Hindu Business Line, they have “a long way to go. The programme is particularly hamstrung by the poor availability of accommodation and, of course, funds.” That being said, Business Line does note that “the clinics are significant and appear to have emerged as a workable model for delivering state-funded primary healthcare of acceptable quality free to the urban poor at an affordable cost to the system.” With the AAP being returned to government in the Delhi elections, the Mohalla clinics are here to stay. Whether the necessary improvements will be made will be seen over the government’s next term.