On visiting many of the Aam Aadmi Party's (AAP) Mohalla clinics in Delhi, some surrounded by stinking heaps of garbage next to clogged drains, it becomes instantly clear that a preventive approach to the city’s healthcare is missing. The recent outbreak of chikungunya and the 12 deaths caused by complications triggered due to the vector-borne disease in the capital, is reflective of the shortcoming in the healthcare policy adopted by the Delhi government.
The revolutionary project of opening free Mohalla clinics to provide primary treatment to residents of small neighbourhoods in the city is certainly a giant stride in curative healthcare. The term revolution owes to the real-life challenges faced in operating these clinics and the fact that they attempt to remove the economic disparity in healthcare by way of providing free basic medical care. All this in a city where out-of-pocket health expenditure is as high as 77 percent as per Delhi human Development Report 2013.
But a health policy opted by a government, be it central or state, is expected to address much more than just curative goals. The stakes are even higher when elections are won based on the assurance of providing universal modern healthcare facilities, as the AAP had done.
In the year 2005, the member countries of the World Health Organisation (WHO) defined universal healthcare as 'securing access for all to appropriate promotive, preventive, curative and rehabilitative services at an affordable cost.' What magic this approach of holistic healthcare can create is very well perceived in the case of Sri Lanka, that recently gained the status of being the second country in South East Asia to be malaria free.
The Sri Lankan government achieved this success by adopting both preventive and curative measures in its fight against air-borne epidemics. Massive pest control drives, use of mosquito nets and repellents along with measures for early detection of Malaria and curbing its spread did wonders for the island nation.
WHO even went on record, lauding the efforts of the Sri Lankan government, by releasing a press release saying that the use of “mobile malaria clinics in high transmission areas meant that prompt and effective treatment could reduce the parasite reservoir and the possibility of further transmission (in Sri Lanka). Effective surveillance, community engagement and health education, meanwhile, enhanced the ability of authorities to respond, and mobilised popular support for the campaign."
Since October 2012, no case of malaria has been reported in Sri Lanka, a country that has historically been one of the most malaria affected countries in the world. The disease claimed more than 90,000 lives in 1935 and in 1999 infected close to 2,70,000 people. The coastal nation's achievement of becoming malaria free is seen as a stupendous success, especially given its recent history of bloody civil strifes.
Delhi Chief Minister Arvind Kejriwal, who declared the eradication of dengue from Delhi as an election promise in the 2015 Assembly election, could well take a leaf out of Sri Lanka’s history in its battle against another vector borne disease; not because the coastal nation’s challenge in this regard matched that of India’s capital city, but because it was far steeper.
The nightmare that the administration must have gone through while implementing the malaria curbing policy in Sri Lanka can hardly be imagined by any Delhiwala babu or neta. In a country that has 65 times more area and more than twice the population of Delhi, in addition to the problems arising from the country’s recent political history, implementation of any policy must have been much more difficult than in Delhi. But Lanka took on the challenge and with the sheer will of its policy makers, it won.
Hence, it is difficult to perceive why it would be so difficult for Kejriwal to follow the Lankan path, and initiate preventive measures to fight vector-borne diseases. With all the financial and administrative resources that Delhi possesses, Kejriwal could have surely done more to fulfil his election promise.
To be fair to Kejriwal, he did have a BJP-led Municipal Corporation of Delhi (MCD) to play the role of an antagonist. It was rightly observed by a few AAP leaders that the cleaning of drains and garbage were the duties of the MCD, which ultimately it failed to deliver on and as a result the clogged drains and heaps of waste became breeding grounds for the disease spreading parasites.
But there is a catch here. Cleaning of clogged drains and garbage heaps are not the only ways to prevent vector-borne diseases, far from it. In fact, it is hard to imagine tropical regions like Sri Lanka without stagnant water and organic wastes to breed parasites.
Most of the credit to Sri Lanka’s success in fighting Malaria goes to the distribution of mosquito-nets, mosquito repellents and measures for early detection of the disease. To implement such preventive policies, the Delhi government would not have required the MCD's help.
Many state governments in India are implementing such measures on their own, without being seen as intruders into the territories of power and functions of the concerned urban and rural local bodies. There is no plausible reason why the Delhi government could not have taken small preventive measure when it managed to establish big-ticket items like the Mohalla clinics in curative healthcare.
Had the Delhi government opted to go the Sri Lankan way, perhaps it could have saved the lives lost to chikungunya in this rainy season and would have protected many more from getting infected. Moreover, it would have been a far matured political move on the part of Kejriwal than foul-mouthing journalists for reporting the deaths caused by chikungunya.
If Sri Lanka stands as an example of a well-conceived and holistic policy to fight Malaria, then Delhi sets the precedence of the perilous consequence of not having one. On account of the lack of preventive measures, the outbreak has spread to epidemic proportions making thousands of feverish patients rush to the Mohalla clinics, leaving the tiny institutions helpless and to some extent ineffective.
In one such over-crowded clinic, the doctor pointed to a nearby drain that had been clogged for several days and said, “This is one of the reasons for the outbreak. We complained to the MCD about it. But only partial cleaning was done after that, leaving a major portion of the drain unclean.”
The dirty drains in Delhi perhaps well represent the dirty politics within the MCD, which can be held equally responsible for the outbreak of chikungunya and the 12 deaths caused by the triggered complications. But whether it is the lack of a better preventive policy by the government or the inefficient implementation by the civic body, it is clear that the issue needs urgent attention.