Mess in the Mohalla?

The AAMC has faced several allegations of irregularities, corruption and mismanagement, including few alleged scams in Delhi as well as Punjab.
(Express illustration | Sourav Roy)
(Express illustration | Sourav Roy)

The present regime in the Delhi government led by AAP won consecutive elections promising basic civic amenities – clean water, an accessible healthcare system, subsidized power, cheap public transport infrastructure, and affordable education.Among them, affordable healthcare resonated greatly with the voters as flourishing private healthcare system and neglected public institutes have been burdening people and their pockets with medical expenses.

The promise of sophisticated health services within budget fructified into the introduction of Aam Aadmi Mohalla Clinics (AAMC) scheme, often touted as a ‘revolutionary’ intervention in healthcare by AAP. The Mohalla Clinic initiative found its way into the AAP manifesto, promised during assembly elections of every state where the party contested. The model is currently being replicated in Punjab where the party scored a thumping majority in the last assembly election. For the AAP, the AAMC scheme has been a vote magnet.

However, cracks have begun to appear in the flagship scheme as several controversies have crowded in recently. The AAMC has faced several allegations of irregularities, corruption and mismanagement, including few alleged scams in Delhi as well as Punjab.

A Central Bureau of Investigation (CBI) investigation into the alleged irregularities in the scheme has marred the scheme’s reputation. The probe specifically targets the construction and operational aspects of these clinics, highlighting issues of financial misappropriation and procedural violations.

Primary allegations involve irregularities in the availability of medical staff, shoddy operations, reluctance towards audit, and fake laboratory tests at these clinics, raising suspicion of kickbacks. The ongoing investigation casts a shadow of doubt over the transparency and integrity of the scheme. Such allegations question the very foundations of the scheme’s apparent welfare motive.The AAP government has been repeatedly denying its involvement in the ‘scams’, instead putting the onus of the alleged irregularities on the bureaucracy.

What are Mohalla Clinics?

The idea behind the AAMC was to furnish ‘mohallas’ (neighbourhood) with affordable healthcare facilities. Launched in 2015 when the Kejriwal-led government assumed power in the city, these community health centers were intended to provide basic medical utilities, including prescription drugs, diagnostic tests, consultations, etc, for free. The clinics have resident doctors, IT-technicians for accessing and archiving patients’ information, and lab assistants for conducting blood tests and dispensing prescribed medication.

“India’s great export to the World”; this is what the Mohalla Clinics’ website had to say about the scheme. It didn’t stop there.”Mohalla Clinics have been lauded, called role model for healthcare by world leaders, academics, researchers, and global news organizations. Former UN Secretary-General, Ban Ki-Moon, and WHO Director-General, Gro Harlem Brundtland, have visited the great Indian model. Prestigious medical journal, The Lancet, has lauded it.”

L-G VK Saxena ordered a CBI probe into allegations of fake diagnostic tests prescribed by mohalla clinics to benefit private labs | File photo, Shekhar Yadav
L-G VK Saxena ordered a CBI probe into allegations of fake diagnostic tests prescribed by mohalla clinics to benefit private labs | File photo, Shekhar Yadav

The initiative was also praised by Former UN Secretary-General Kofi Annan who called the project “a model for all Indian states embarking on the journey to Universal Health Care.”What visibly changed after the introduction of Mohalla Clinics was the political discourse around public health. The initiative brought health services to the fore of political agendas, with number of states expressing interest in adopting the concept (or a variant), like ‘Namma’ clinics by the previous BJP regime in Karnataka.However, amid all lauds and propaganda, the initiative has been unable to distance itself from the murk of controversy.
‘Fake’ tests on ‘ghost’ patients:

Misappropriation of hundreds of crores?

In August last year, it came to the notice of the Department of Health and Family Welfare that several doctors posted in seven AAMCs in Shahdara, North-East & South-West districts resorted to unethical practices, manipulating attendance records with pre-recorded video footages, marking ‘present’ while remaining absent.In the duration of their absence, patients visiting the clinics allegedly consulted the staff empanelled at these clinics, who even provided prescriptions and distributed drugs, without competence or authority to do the same.

In September, disciplinary action was taken against these doctors. They were de-empanelled from the Delhi government and FIRs were registered against them.These irregularities prompted the health department to initiate a preliminary probe after directions from the vigilance department who suspected a nexus behind the curtains, involving private laboratories where diagnostic and radiology tests of the Mohalla clinics have been outsourced by the city government.

“In October, a review of the lab testing data (retrieved from the web portals of two outsourced diagnostics lab) was conducted. For a random analysis of lab data for three months, July – September ’23, in Metropolis and Agilus, Lab Management Information System (LMIS) showed, during the period when the ‘fraudulent’ doctors were manipulating attendance records, lab tests are being prescribed to patients, recommended without the presence of consulting doctors in clear violation of SOPs laid down,” the health department’s preliminary inquiry document stated.

The vigilance department probed further into the murky depths. Findings revealed that initial digits of the mobile phone numbers collected for maintaining record of patients to whom tests were prescribed, started with 1, 2, 3, 4, and 5, phone numbers that do not exist in India. It also showed that thousands of tests were prescribed to people having different names yet a single mobile numbers. Besides, 20,000 medical test records either had no mobile number or simply ‘0’ as the entry.

Patients at a Delhi government-run Mohalla clinic at Nizamuddin, New Delhi | File Photo
Patients at a Delhi government-run Mohalla clinic at Nizamuddin, New Delhi | File Photo

Officials said the irregularities unearthed in the probe were recorded in a mere three months time, during which over 6 lakh tests were conducted at the two labs. The irregularities are indicative of a ‘scam’ that may run into hundreds of crores, allegedly done to provide monetary benefits to the private labs, officers remarked.

After the revelation, L-G V K Saxena promptly recommended a CBI inquiry into the matter. Critics speculated that the same model of ‘misappropriation’ is in force in AAP-ruled Punjab. The Union Home Ministry gave its nod to the probing agency to investigate the allegations. Meanwhile, the Anti-Corruption Branch (ACB) of the city government will assess data of all private labs empanelled with the Delhi government to provide diagnostic support to public health facilities including AAMCs, dispensaries, polyclinics, and hospitals, from the time they started operating. The data will be furnished to the CBI for a detailed probe.The CBI, however, is already investigating alleged corruption charges on a similar front, where too, involvement of Mohalla Clinics’ is now being suspected.

‘Spurious’ drugs in crucial treatments?

Last month, L-G recommended a CBI inquiry into the procurement and supply of allegedly spurious drugs to people at Mohalla clinics and few hospitals under the city government.According to allegation, certain drugs, available at government health facilities, failed quality standard tests and were even potentially life-threatening for a vast population as they were prescribed for the treatment of a range of illnesses. The drugs include antibiotics, steroids, anti-anxiety pills, and hypertension.

The quality test came after complaints were reported by several patients. Samples were collected from three major hospitals, IHBAS, Lok Nayak, and Deen Dayal Upadhyay, catering to lakhs of patients.
The Drug Controller of the city government randomly collected 86 drug samples from these hospitals and sent 43 each to approved government and private labs for testing. Over 10% of the samples failed the quality test. According to the vigilance department, out of 43 samples sent to government labs, three samples failed the test, 12 reports still pending. Out of other 43 samples sent to private labs, five samples failed.

L-G Saxena, recommending the CBI to conduct a probe, noted that apart from the Central Procurement Agency supplying drugs in the city, manufacturers and suppliers operating out of other states, and drug controllers in respective states may be associated with the ‘malicious’ exercise and should be investigated.
The CBI is probing the case and has sought all relevant documents related to procurement and supply of medicines from the city government.

Controversies around the Mohalla

AAP promised Mohalla Clinics during the Punjab assembly election. Following their victory, the newly-formed government hurried to implement the much-hyped Mohalla Clinic. Critics found this a desperate attempt to squeeze a healthcare model for political juice. Dispensaries as part of AAMCs: Allegations flew that AAP is converting existing area of ‘Sewa Kendras’, primary healthcare units attached to district hospitals, into AAMCs. The government was also accused of turning rural dispensaries into Mohalla clinics.

At the cost of primary healthcare: AAP-led Punjab government was accused of launching Mohalla clinics in already operating primary health centers and health sub-centers across the state. The move was heavily criticized with critics alleging AAP used existing health infrastructure to fulfill their election manifesto.

Diverting healthcare staff to run AAMCs: Doctors and paramedical staff were transferred from the existing health facilities in rural Punjab to manage AAMCs. The transfer of manpower from rural dispensaries rendered them non-functional, forcing locals to protests. Under pressure from local residents, the government deputed community health officers (CHO), non-physician health workers, at subsidiary health centers as replacements for doctors who were shifted to AAMCs.

‘Ayushman Bharat’ to Mohalla clinic: The Centre threatened the Punjab government to slash the central funding for the National Health Mission in the state, observing that Ayushman health and wellness centers were “rebranded as Aam Aadmi clinics”. In a strongly worded letter, the Ministry of Health and Family Welfare said it would cut off funding of nearly Rs 676.11 crore for enhancing health infrastructure “if the state continued to convert centrally funded Ayushman Bharat health centers into Aam Aadmi clinics”

Any takeaways?

The controversies are potent enough to undermine the credibility of the Mohalla Clinic model, earlier lauded as a progressive healthcare solution. Amidst allegations and investigations, AAP also faces a critical challenge of restoring public faith in its healthcare initiatives.

Transparent investigation, accountability, and genuine efforts to rectify flaws are imperative to salvage the credibility of the flagship scheme and, by extension, the party’s commitment to governance and public welfare.

As the CBI inquiry continues, it is essential to remember the intent of the Mohalla Clinic scheme, addressing healthcare needs of the marginalized. Whether it continues to fulfill this cause or succumb to corruption remains a crucial question in the discourse of governance and social welfare in the Capital.

‘Ghosts’ show up for tests, Contact number ‘0’

3092 tests were recommended for mobile number ‘9999999999’ for different patients
Mobile numbers '9810467129' and '9855544543' were used to register 350 patients
11,657 tests were recommended for mobile number where 'O' digit
was entered
8,199 tests were recommended for "Blank" mobile numbers
42 tests were recommended for fake mobile numbers starting from digits '1', '2', '3', '4' and '5'
817 Mobile numbers occurred for 15 or more times

Spurious drugs under scanner

  1. Cephalexin a life-saving antibiotic for treatment of lung and urinary tract infections
  2. Pantoprazole proton pump inhibitor for treating stomach ulcers
  3. Levetiracetam an anti-epilepsy and anti-anxiety psychiatric drug
  4. Dexamethasone a steroid for curing life-threatening inflammation in lungs, joints and swelling in the body
  5. Amlodipine lowers blodds pressure; prescribed to patients of hypertension
  6. Sodium valproate an antiepileptic medication that controls seizures or fits in epilepsy

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