“Too many Cooks spoil the Broth “. This saying aptly fits Delhi’s healthcare system. It is highly heterogeneous with multiple stake holders…
By Dr Vinay Aggarwal
Though the health is a state subject, National Capital Delhi’s healthcare is provided by Central government, State government, ESI, Railways, NDMC, MCD, Cantonment board, Delhi University. etc from the govt sector alone. Besides these there are many corporate hospitals, charitable hospitals to small Nursing homes and clinics, run by the private sector. However a large chunk of population, especially the low and middle income group, not only of Delhi but from neighboring states depends on the government sector hospitals and dispensaries.
The plethora of agencies is responsible for quality of health care not being uniform. Different agencies have different priorities or budgetary and other logistic constraints. The agencies are also under different a political party at times which exacerbates the differences of vision and approach. This is best exemplified by the state of Hospitals being run by the 3 Municipal corporations of Delhi (MCDs). Their situation is so pathetic that even Doctors and other healthcare workers most of the time have to strike work to get paid.
The genesis of this financial crisis lies in the trifurcation of the erstwhile MCD in 2012 by the Shiela Dixit’s government. Since their inception, the three MCDs are facing huge financial crunch. Three MCDs mean increase in expenditure on separate administration for each. The imbalance of revenue sources and services provided has left South MCD being richer while East and North have little money but much more to spend on. The basic services like sanitation, roads, were already suffering which got exacerbated with the advent of COVID. The ongoing tussle between the two political adversaries in MCD and Delhi government has added fuel to the fire.
The MCDs are also accused of being victim of massive corruption. The situation is grim and the ultimate suffererers are common people and thousands of municipal corporation employees including Healthcare workers. This dismal show is reflected when the MCDs get the dubious distinction of being bottom most on All India comparison. The salaries of the MCD workers are disrupted frequently leading to lots of hardships. Arrears have not been paid for last 5 years, salaries are paid after months, pension to the retired employees are also delayed for months even the retirement benefits to employees retired 3-4 yrs back have not been given.
The7th Pay Commission Recommendations have yet not been implemented. This systematic suffering of the employees has also allegedly led to lot of hardships and even in occasional cases suicides have also been reported. The Three municipal corporations have many dispensaries and quite a few numbers of hospitals under them. The prominent of them are Hindu Rao hospital, Kasturba Gandhi hospital, Rajan Babu TB hospital and Infectious Disease hospital under NDMC and Swami Dayanand Hospital under EDMC. Hindu Rao hospital is also running a Medical College which is also financed by NDMC. The dispensaries and hospitals of MCDs treat lots of patients daily.
Most of the patients catered to belong to poor classes who have nowhere else to go. It is quite evident that the financial crunch will affect the overall effective healthcare management, due to lack of equipments, Diagnostics, medicines and other health related items. Buildings require lot of maintenance, no new technology or equipment’s are added. Recent incident that happened in Swami Dayanand Hospital where a child and mother were seriously injured by falling of the plaster from roof of the ward in which they were admitted are evidence of crumbling infrastructure.
This clearly shows that MCD’s are unable to run the Public Healthcare delivery. What is the solution? A serious introspection should be done about taking away the healthcare provision from MCDs. It is a department which generates very less revenue but requires huge sums to be spent on it. If MCDs are divested of this public duty they would be able to spend on sanitation, road improvement, pollution control, revenue collection etc. It would unshackle the MCDs from carrying this load. In any other state the hospitals could have been transferred to State government but Delhi being unique even Central government can be asked to take over some of these hospitals or divide them amongst the State and Central .
It would be a relief also for the healthcare workers who have to go without being paid for months. The infrastructure too would improve leading to better services. It shall also decrease the load on Tertiary care centres because many cases requiring secondary level care won’t flood their centres. It is a “win-win” situation. State government would get more dispensaries to augment its already running healthcare delivery plus the hospitals which it can upgrade without having to construct new ones. The staff would be at mental peace regarding payment of salaries, pensions and other benefits. They would be free of worries and able to concentrate on providing healthcare & be accountable.
The MCDs would not have to feed the proverbial “white elephant” anymore. Their revenue generation would be impacted very little while expenditure would come down substantially. General public would get better services and would have one agency less to deal with. Hopefully even courts wouldn’t have to devote time in resolving the tussle between MCDs and Delhi government despite being ruled by different political parties.
All it needs is the will of the top officials of the government. The Lt. Governor of Delhi should take the lead as he is constitutionally the head of Delhi’s administration. He should ask Delhi government and MCDs to formulate a road map for this change. If it happens it would be a “game changer” in how Healthcare is delivered in Capital of India that will benefit all stakeholders specially the public.
(The author is Past National President IMA and the recipient of Dr B C Roy National Award)