Despite gaps, AAP's Delhi healthcare model is an example for others

medium nocaption117462217During Aam Aadmi Party's (AAP) first full tenure from 2015 to 2020, healthcare and education had emerged as the party’s primary focus areas. The mohalla clinics, in particular, garnered international acclaim for providing accessible healthcare at the grassroots level. This prompted the then chief minister, Arvind Kejriwal, to once remark, “If you receive free medicines and quality treatment, it’s a Delhi government hospital; if you are being charged, it’s a central government hospital.”The city has 39 state-run hospitals, eight run by autonomous bodies, 427 dispensaries, 546 mohalla clinics, 30 polyclinics and eight medical colleges. One of the most transformative steps was the introduction of mohalla clinics, a network of neighbourhood healthcare centres providing free primary care, diagnostic tests and essential medicines. “The first one came up in October 2015. By end of last year, over 500 clinics were serving lakhs of patients annually,” said a Delhi government official.The state budgets have reserved a large chunk of allocation for healthcare. The amount grew from Rs 4,787 crore in 2015-16 to Rs 8,685 crore in 2024-25. Add to this several patient-friendly schemes — free tests at private labs, referrals to private hospitals, and treatment for victims of road accidents and acid attacks. Recently, the state government also announced the Sanjeevani scheme, in which Delhiites above 60 years will get free healthcare services. That is why the state government's claim that Delhi had a better scheme to offer people than the central government's Ayushman Bharat.Dr Sunil Singhal, senior vice-president of Delhi Medical Association, said, “The healthcare services in the city have improved over the years. There are some gaps in demand and supply in government hospitals but these can be closed with focused initiatives.”An RTI reply said that there were nearly 1.4 crore appointments in mohalla clinics in 2024. Parveen, 48, of Govindpuri, said, “The mohalla clinic has benefited us a lot and we fear these will vanish if someone else comes to power.” Some doctors agreed this was a step in the right direction as decentralisation in healthcare was important. “I went through the reports and blood samples collected by mohalla clinics, and the quality of the whole process was good. It is an effective model,” said a doctor, member of a panel that evaluated the functioning of these clinics. medium nocaption117445172Falling short in 2nd termAAP’s second term has seen a blunting of the sharpness of these initiatives. The mohalla clinics were short of medicines, hospital construction missed deadlines and existing medical facilities struggled to meet patient demands. Before the 2022 municipal elections, reports also surfaced about the unavailability of diagnostic tests in mohalla clinics. AAP representatives claimed these disruptions were politically motivated, accusing the lieutenant governor of stalling services to undermine the elected government's popularity ahead of the polls.However, some people argue that while the mohalla clinics are effective in theory, their operations have been deficient. “In the mohalla clinic, we don’t even get a cough syrup on the days it is open. On other days, it remains closed,” alleged a resident of Valmiki Basti in Delhi's Ambedkar Nagar. At Sultanpur Dabas, the clinic had empty rooms and trash strewn on the premises.Delhi health minister Saurabh Bharadwaj said only those mohalla clinics that have low footfall or lacked staff were closed. “Of 546 clinics, around 20 faced such problems. At all the others, we received positive feedback from residents,” he claimed.As for the hospitals, some reports highlighted the crumbling infrastructure in several of them, citing the outdated equipment and overcrowding as persistent problems. In 2024, the Delhi high Ccourt observed that the medical infrastructure in the capital was inadequate and the number of hospital beds insufficient. At the time, Delhi government hospitals had 1,058 ICU beds which, a committee of experts said, needed to be enhanced to 2,028. The experts pointed to an “inadequate” number of quality operation theatres and pre-and post-operative facilities, as well as non availability of essential equipment, ultrasounds, CT/MRI scans, anaesthesia machines, and a perpetual shortage of medicines. A doctor said, “Manpower, technical support and infrastructure need to be taken care of. A practical referral system is also important.” medium nocaption117445227 medium nocaption117445253Resource crunchIn September 2024, with more than Rs 10,250 crore reportedly needed to complete the construction of 24 new hospitals and add new blocks in the existing ones over a period of three years, and another Rs 8,000 crore needed every year to run these facilities, the finance department flagged a serious “resource crunch”.The health minister dismissed these claims. “75-80% of the hospital projects are complete. The LG needs to initiate the recruitment process by writing to UPSC, which will announce the entrance dates and conduct the hiring — a process that will take two years,” said Bharadwaj. “If we complete the hospitals now, they will deteriorate by the time recruitment is finalised. Govt has the resources to finish the remaining 15% of the work.”The medicine shortage, according to health department officials, reportedly stemmed from delayed vendor payments and changes in tender conditions which led to two-thirds of the pharmaceutical companies opting out. The official said all dues had been cleared and everything was now getting back on track. medium nocaption117445339Staffing is also a challenge. With thousands of vacancies, both mohalla clinics and government hospitals lack doctors, nurses and technicians. Delhi Medical Association has repeatedly called attention to the strain this places on existing staff. “A dedicated medical cadre should be established and exams should be conducted to fill the vacancies. Also, to attract qualified doctors, it is essential to provide them with adequate facilities and make the profession more financially and professionally rewarding. In addition, govt must prioritise consistent supply of essential medicines,” said Singhal.Despite some setbacks, experts believe that Delhi’s healthcare model is an example for other states. The incoming government will be expected to build on these achievements.