Finally! Mohalla Clinic Is Reality

Mohalla-Clinic-in-Delhi

While approving Mohalla clinic, Baijal said that administrative department would evolve an online system within six months which would be based on Aadhaar for better monitoring          

By Anil Anand

The dispute between Lt Governor of Delhi and Arvind Kejriwal-led Aaam Aadmi Party government over opening and subsequently expanding the mohalla clinic scheme is more an index of fierce turf war going on between the Centre and the semi-state that Delhi is. Two years of AAP government and with one Lt Governor Najib Jung perishing fighting down the turf war, the dispute at least on the crucial Mohall clinics expansion still persists with his successor desperately trying to come to terms with chief minister Arvind Kejriwal and, of late, the latter beginning to see merit in reconciliation.

 The change of guard at the LG House, from Jung to former Home Secretary Anil Baijal, has some salutary effect as both sides, Baijal and Kejriwal, ostensibly thought it prudent to find a workable solution. The solution lies in between the absolute power that Kejriwal claims by dint of having secured a brute majority in Delhi Assembly through totally decimating the opposition, and the Constitutional powers that Lt Governor enjoys in the current schemes of things being the Centre’s nominee. There are indications of certain issues being sorted out but it is still easier said than done.  The aggressive nature of the leadership at the Centre, if not Baijal, and Kejriwal a firm believer in politics of confrontation, it will be interesting to see how this logjam ultimately breaks, if at all.

So at the first instance why a spat on a crucial health related issue such as Mohalla clinics and why the need for reconciliation? In fact, this has not been the only point of confrontation between LG (read BJP-led NDA dispensation at the Centre) and AAP government in Delhi. Kejriwal buoyed by his 67 out of 70 score in the Delhi Assembly elections has been using it as a tool to assert his political authority and as a mean to see AAP growing in rest of the country. An equally politically aggressive BJP leadership saw through his plans which ran parallel to their political designs. 

So the confrontation, with Centre’s representative Lt Governor becoming the focus of confrontation and a villain of piece as he was seen in becoming a stumbling block in the functioning of a democratically elected government. This discourse was successfully built by team Kejriwal and to a great extent managed to convince the public. Thereby, the current constitutional scheme of things under which the LG enjoys more powers was relegated to the backdrop in this debate.

What better than building confrontation on a health related issue which touches every individual to attain victimhood? The AAP government launched its ambitions scheme nearly two years back in an absolutely confrontationist mood. The then LG Najib Jung reacted in an equal measure raising objections and delaying relevant permissions. Nevertheless, the scheme rolled on and 158 such clinics out of a targeted 1000 were set up with the controversies persisting and chasing both Jung and Kejriwal.

 It is another matter that defeat in Punjab Assembly polls put a spoke in Kejriwal’s plans and there was a visible shift in his strategy. The realisation seemed to have dawned on him that working quietly to deliver on election promises rather being loud and confrontationist was the road to success.

However, the chinks in his mohalla clinic schemes and the manner of implementation continued to evoke resistance both from LG House and opposition parties. Serious questions were being raised on Kejriwal’s current model of mohalla clinics and charges of favouring AAP cadres in the setting up of these clinics flew thick and high. So the expansion plan got stuck.

Suddenly came the news of a strong contingent of AAP MLAs laying siege at the LG’s office, and refusing to vacate the same without the relevant file related to clinic expansion plan being cleared immediately. A restive Kejriwal in some respects broke the truce while the seasoned administrator Baijal was weighing his options when the AAP-made catastrophe landed over his head.

Finally, Baijal decided to give approval to mohalla clinic expansion plan to diffuse the situation but it came with some riders. Since the Kejriwal government has not, till date, opposed the conditional approval, it is being construed both by the LG House and the opposition parties Congress and BJP as acceptance of his mistakes by the AAP supremo.

While approving the Mohalla clinic proposal, Baijal said that the administrative department would evolve and migrate to an online system within six months which would be based on Aadhaar or biometrics of patients for better monitoring. It was also stated that to ensure that there is no compromise on the quality of healthcare, the doctors and staff engaged in these clinics should be properly qualified and they should be engaged through a transparent mechanism.  Appointment of doctors and staff and renting out premises for setting up clinics were the two controversial issues, among others, that led to the project being delayed.

This development came in the backdrop of Kejriwal’s statement that there should be no politics on mohalla clinics and the LG should sort out the issues across the table. This statement came as a surprise to all as it indicated softening of stand on his part and at the same time admission of procedural lapses.

The political controversies apart, it is in order to pin-point some of the discrepancies and lapses noticed in the scheme so far. On ground surveys revealed startling facts that some doctors were claiming to have examined, at an average a patient in 36 seconds as against the mandated 7 to 10 minutes per patient which meant examining 24 to 34 patients per clinic per day. The numbers of patients were being fudged by them to raise their salary bill as doctors are paid a flat rate per patient. This has led to some doctors making up to Rs 4 lakh per month without actually doing the work as against Rs 70,000 per month being paid to junior residents in hospitals after putting in 48 hours duty per work as mandated by the Supreme Court. But despite that these doctors put in around 100 hours per week. As against this the mohalla clinic doctors work for 4-hours a day.

On a more serious note out of 158 clinics operated from rented premises at least 102 were from places that belonged to AAP leaders and workers.

According to data of the Health and Family Welfare Department of Delhi government, a total of 158 mohalla Clinics saw 10.76 lakh patients from January to March this year. In comparison, 61 seed primary urban health centres or PUHCs of the department had an out-patient attendance of 20.49 lakh for the same period.

In a letter, the Department had raised 11 points of concern to which it sought replies from the Directorate General of Health Services (DGHS) and the Chief Medical District Officer (CDMO). The former DGHS has already submitted his reply to the department.

Discrepancies apart the matter could have been sorted out earlier also but for the stubborn attitude of the then LG and to some extent Kejriwal viewing the issue in terms of political benefits. Will this truce prevail only time will tell.