A centre of attraction during the Punjab election campaign, the flagship initiative of the AAP government faces its own set of problems ranging from space unavailability, shortage of staff and lack of cleaniness. Ankita Upadhyay speaks to residents and clinic staff to highlight the issues faced by them
DELHI: Pictures of former UN chief Ban Ki-moon and Delhi CM Arvind Kejriwal jostle with clean Aam Aadmi Mohalla Clinics on the AAMC website. For good reasons, these clinics are synonymous with the Aam Aadmi Party’s claim of good governance — a major poll plank for the party in Punjab.
But there are more to the flagship mohalla clinics than meets the eye. When the Morning Standard visited some of these clinics in various parts of the city, glaring problems such as space crunch, shortage of doctors and even lack of cleanliness were stark.
A look at some of the stumbling blocks that affect the functioning of one of the government’s flagship initiatives meant to boost the primary healthcare system.
Shortage of manpower and resources
In his budget speech on March 26, Deputy Chief Minister Manish Sisodia announced to set aside `475 crore for mohalla clinics and polyclinics. One of the purposes of the fund was to hire more doctors, nurses and other staff. While the Delhi government’s target is to open 1,000 AAMCs with one doctor each, the sheer load on doctors mean more and more poor people are heading to government hospitals. Documents accessed by The Morning Standard showed the gaps at the district level and suggested that the health department plan to conduct written examinations for recruitment of doctors on the same lines as those taken for other medical staff.
The doctors working with AAMC conceded that the workload is immense and they do not have the required number of staff to deal with the rush of patients. According to Dr Aasia Hasan who works at a mohalla clinic in Usmanpur, there should be at least two doctors in every clinic to manage the rush of patients in a better way. “Currently, four people including a doctor operate at the clinic but the patient load is immense. If we see more than 120 patients, then the quality of work is affected. You will have to come to my clinic to understand the immense patient load,” says Dr Aasia, an empanelled doctor who gets her salary based on the number of patients she attends to.
On days of emergencies, she said, the clinic has to be shut resulting in the deduction of salaries of other staff. ‘‘Because of limited staff, not many rely on us. They avail treatment in private hospitals and come for medicines. Sometimes I feel that I am only providing free medicines instead of consultations. It is because the patients don’t trust mohalla clinics.”
On occasions, medicines also run out of stock which affects the poor patients. “There are issues with the tenders which have been passed by the government due to which the medicines have remained out of stock for several days’ said a health official. The absence of medical equipment, which can be procured easily, also is another stumbling block.
According to 45-year-old Narendra Kohli, a resident of Bakkarwala, facilities like X-ray machine should be available in mohalla clinics. “We are happy to get free medicines and check-ups but Mohalla clinics are only limited to that. Some more facilities can be easily provided. The doctor prescribed an X-ray as my shoulder is hurting. I will have to reach another place for it,” he contended.
Unhygienic conditions
The concept of mohalla clinic is based on being a linkage between the local community and the higher health care facilities. As such, these facilities are mostly located in slums and jhuggi clusters. Despite the free medicines and cheap treatment, the unhygienic conditions of slums and jhuggi clusters have become a major drawback when it comes to maintaining the general health of the people.
One such clinic in Meera Bagh Slum Cluster has extreme unhygienic conditions due to which the residents suffer from skin and waterborne disease. When this reporter visited the slum, a strong stench from the Najafgarh drain filled the air. Swarms of flies and overflowing drain water made it unbearable.
In such conditions, health care authorities assert it is altogether a challenging task to not only provide health facilities but also run awareness campaigns. “Most of the patients have skin- and stomach-related issues,” said a doctor deployed in the local clinic. However, there is no such awareness campaign for the people to keep the area clean, he added. ”We ran a cancer awareness campaign recently but that was all.”
Ranvir Kumar, a resident, said there was not much a mohalla clinic can in such an area. “In monsoons, the drainage water overflows and enters inside our house. You cannot stay after 5pm. During the day, flies swarm the area and mosquitoes don’t let us sleep at the night. As summer is here, diseases like dengue and malaria will again grip the area.”
Several other mohalla clinics in South West area are also affected by unhygienic conditions. According to Shaurya Kataria of Vikas Puri, there is garbage all around the clinic close to his house. “I took my sister to get a thyroid test done on Saturday and I observed that no one bothers to keep the surrounding area clean. There was no place to sit inside. While we waited outside the clinic, there was garbage all around.’’ When contacted state nodal officer for mohalla clinics, Dr Shalley Kamra was unavailable for statement.
Space Constraints
As these clinics mostly operate from one room rented facility setup or porta cabins, officials say limited space makes it a challenging task to conduct tasks like blood sampling, immunisation and blood testing. At a clinic in Peeragarhi, the Covid vaccination for children was being conducted in the open. “We are worried as we don’t have space inside. With the mercury rising each day, it will be a challenge to maintain the temperature needed to store vaccines,” said a doctor.
She added that on an average, the clinic get 150-200 patients who mostly come for medicines for various health ailments. “We consult patients and provide them medicines but this is not helping in reducing the load on secondary and tertiary health facilities because there is still a long way to gain trust of people. The patients visit us but then again are given the same treatment at a private hospital. They still don’t have confidence in us.”
Pinki, 28, a lab technician who recently lost her job after the government removed around 600 contractual employees, says that while on duty, she had to take blood samples out in the open because of space crunch. “We didn’t even have place to sit. Collecting samples out in the open is a risky thing. There should be a separate room for blood sampling so that everything remains in order.”
According to the data shared by the health department during the just concluded budget session of the Delhi Assembly, a total of 520 mohalla clinics have been opened in Delhi (24 of those having evening shift). While 326 mohalla clinics are running in porta cabins, 166 are housed in rented facilities, and four operate out of ‘Basti Vikas Kendra’.
Scope for doing better
While the mohalla clinics are mostly functioning in the slums and outskirts of Delhi, the work of doctors are only limited to giving consultation and medicine. With illiteracy and poverty rampant, free medicines and checkups cannot solve the problems, they said. “We get to understand the traumas, and the problems of the people. Women and girls in slums share their woes with us. When we work up with people, they open up with us and today we have so many people who avail treatment without any hesitation,” said a mohalla clinic doctor who is also associated with the National Health Mission. The doctor adds that the Mohalla Clinics will succeed only when the doctors and the staff give full focus to the local community.
Doctors minting money?
Contrary to what Dr Aasia stated, there are also allegations that the empanelled doctors fudge the number of patients to earn more money. Doctors get `40 per registered patient, with a minimum assured guarantee of 75 patients daily. According to sources, the doctors allegedly fudge the number of registrations done on a daily basis