Healthier Delhi

Universal health coverage is meant for all people to avail, preventive, curative and rehabilitative care to achieve wholesome health in a convenient manner that does not threaten to cause financial hardships, pushing them in a downward spiral of poverty induced by ill-health.

It was in 1983 that the Indian Parliament adopted 'National Health Policy' with a target to achieve 'Health for All' by 2000 which was later revised to the year 2002. A slew of measures was announced to get this going. The objectives mentioned were to increase GDP spending on health to 2 per cent by 2010 and to increase state spending from 5 per cent to 7 per cent by 2005 with Centre contributing 35 per cent share for state health programs. However, atrociously low expenditure on health by successive governments and dismal priority attributed to building health infrastructure and manpower has failed to realize this dream that India saw 36 years ago.

India's Constitution mandates each state with providing health care for its people. Most of the planning and visualiSation around vital areas as health and education is done by state machinery and its think tank that reflects upon their people's wellbeing and growth.

Delhi is a stellar example of taking universal healthcare seriously and implementing it insidiously yet firmly.

It was very early in their tenure that Aam Aadmi Party government in Delhi realiSed the fundamental flaws in existing healthcare delivery with absolutely no priority given to primary health in this mega-metropolis with a population exceeding 22 million. This, besides floating populations of lakhs of people coming from adjoining states for work or in hope of finding decent medical services made for a large and complicated pool of demand flanked with crumbling infrastructure that was costing more and yielding less.

2015 was the watershed year. Aspiration and expectation, both, were running through the roof and they needed a magic wand to sort this out. Sometimes it takes simple solutions to sort out big problems. Delhi applied its mind for just that.

Before AAP took over Delhi in 2015, approximately 72 per cent of Delhi depended on the private sector for their health needs. Health budget stood at a meagre 3 per cent and government hospitals were being crushed under a load of all sorts of patients that need not come to them. Dispensaries were underperforming with high overheads and low outputs. Polyclinics were nonexistent.

Private hospitals and nursing homes have always been expensive, therefore, out of bounds for the majority. One bout of illness followed by hospitalization could set a family below the poverty line. Those who couldn't pay went to quacks and risked their health.

As per NSSO survey in 2016, more than 83 per cent of Delhi had no health insurance of any kind and the 17 per cent who had one were either too little or too cumbersome to rely on in times of health emergencies. Out-of-pocket expenditure saw people losing their life's savings on expensive healthcare.

The scenario changed with a three-tier health system proposed by the state government. They had health professionals guiding them into the crux with an ingrained attitude of economising and zero tolerance to corruption and wastage of money. They were able to float in the concept of 'Free of Cost' healthcare at all three levels.

The integrated axis of Primary, Secondary and Tertiary Health was established with the help of Mohalla Clinics, Polyclinics, Tertiary and Super speciality hospitals. The experiment was successful from the beginning giving, them necessary impetus to consolidate it further.

Aam Aadmi Mohalla clinic and Polyclinics were just the beginning for this stream of universal health care delivery. Approximately 80-85 per cent of all health care needs could be catered to through this axis.

Cashless, convenient and correct treatment at these neighbourhood clinics is getting popular with citizens and it does save them time and money. Diversion of small cases to mohalla clinics is likely to decongest tertiary hospitals.

Going beyond OPD treatment, in the year 2017 Delhi government made 'Delhi Aarogya Kosh' as the apex body to fund and reimburse the cost of high-end investigations. These can now be done at the empanelled centres absolutely free of cost. This was the most unique example of starting systematic and steady public health insurance one by one. All these services and surgeries can be done at empanelled private hospitals for no cost only after getting the referral and Pre- Anaesthetic DAK is working as 'Trust-Based model' or universal health insurance with an exhaustive list of 133 high-end diagnostic tests and 1155 surgeries and procedures. Additionally, the Farishtey scheme, which ensures cashless treatment for all accident victims, further increases the ambit of provisions to achieve universalisation, particularly in cases of emergency.

With 14 per cent budget allocated to Health and 26 per cent on education, Delhi is already a role model for other states. Delhi's model of UHC is the least discriminatory public health scheme. Its entitlements are not linked with income, family size or socio-economic background. Such a model, which exemplifies smart economics and frugal yet inclusive approach, is bound to create giant strides towards better public health.

Dr Nimmi Rastogi is a Member of Dialogue and Development Commission Delhi, Consultant Gynecologist & Obstetrician. Views expressed are strictly personal