Modicare and Mohalla Clinics: Assessing India’s two health models

As India’s general election winds down, Al Jazeera reports on two most talked-about health initiatives in the country.by Nadim Asraran hour ago

New Delhi, India – Vinod Prasad Jaiswal had lost all hopes of recovery after he was diagnosed with oesophagal stricture, a condition in which the oesophagus gets narrow and makes swallowing of food difficult.

The 57-year-old scrap dealer needed immediate surgery but didn’t have the money. It was then that somebody suggested he should make use of the Pradhan Mantri Jan Arogya Yojana (PMJAY, more popularly known as “Modicare”) scheme, a part of the federal government’s Ayushman Bharat health programme.

It was in Jaiswal’s hometown Ranchi, the capital of Jharkhand state in eastern India, that Prime Minister Narendra Modi had launched his flagship PMJAY health insurance scheme in September last year.

‘Modicare’

Billed as the world’s biggest healthcare insurance programme, PMJAY provides free health cover of Rs 500,000 ($7,100) a year for serious ailments to 100 million poor families or about 500 million people. The federal government bears 60 percent of the premium while the state governments bear the remaining 40.

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“We didn’t have any health insurance, so we got the Ayushman health card made,” Jaiswal’s son Gaurav Kumar told Al Jazeera. “We had a lot of faith in that card.”

That faith made Jaiswal travel over a 1,000km to New Delhi’s privately-owned Sir Ganga Ram Hospital, where he became the first person to be admitted under the “Modicare” scheme. The surgery was conducted last month and he is now recovering.

Incidentally, Jaiswal was the first beneficiary of the PMJAY health insurance scheme at Sir Ganga Ram Hospital, which in turn is the first multi-speciality hospital in New Delhi to join the Ayushman Bharat panel.

New Delhi along with Telangana and Odisha states did not sign up for the Ayushman Bharat scheme. As a result, hospitals in the national capital could only treat people from outside the city.

West Bengal state, which is ruled by a regional party opposed to Modi, pulled out after initially signing up to the scheme.

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“We went beyond our mandate to join the Ayushman Bharat scheme,” Sir Ganga Ram Hospital’s additional director of medicine Dr Satendra Katoch told Al Jazeera. “At least three other hospitals in Delhi have made queries after we admitted our first patient.”

The ruling Bharatiya Janata Party (BJP) spokesperson GVL Narasimha Rao told Al Jazeera that more than 1.5 million people so far have benefited from the PMJAY scheme.

“It will take year or two to get completely streamlined because more and more hospitals are joining the scheme,” he said, calling it a “roaring success”.

Two models of primary healthcare

Apart from the PMJAY scheme, the federal government’s Ayushman Bharat programme also has a primary healthcare component called the Health and Wellness Centres (HWCs).

Health experts say while the HWCs are a more comprehensive healthcare model, the money put in the programme is inadequate.

“The HWC is a gradual expansion of the existing healthcare system. It is a more integrated system because it is trying to strengthen not only clinical care but also other elements like preventive measures and diagnostics,” Indranil Mukhopadhyay, who is an associate professor at OP Jindal University on the outskirts of New Delhi, told media.

Mukhopadhyay argued that spending on a scheme such as PMJAY makes little sense since the thrust of the expenditure should be on primary healthcare.

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“Spending more money on primary healthcare will save more money in the long run. If you look at morbidity and deaths which were preventable, you would realise a good screening programme or access to basic medicines could reduce dependence on tertiary institutions.”

The poll manifesto of the BJP, which is hoping to be re-elected in the ongoing general election, said 17,150 HWCs have become functional across India while there are plans to upgrade 150,000 health sub-centres into HWCs by the year 2022. 

Meanwhile, In India’s capital, a health programme – the Aam Aadmi Mohalla Clinics (AAMCs) – launched by the city government run by the Aam Aadmi Party (AAP), is also being talked about and even compared with the central government’s health initiative.

The refusal of the New Delhi government to join Ayushman Bharat, it seems, is also attributed to the AAP’s confidence in its flagship AAMC programme.

Aam Aadmi Mohalla Clinics

Launched in 2014, the AAP promised 1,000 such clinics across New Delhi to cater to its 19 million residents, mainly the poor, apart from a large number of city’s floating population of migrants.

Each AAMC in New Delhi was planned within a radius of 5km, with a large number of them opening around lower-middle-class neighbourhoods and urban slums.

Mehjabeen Khatoon, 36, said she had been visiting the AAMC in New Delhi’s Okhla area for the last two years.

“The medicines we used to buy from stores are costly while we find the same medicines here free of cost and the quality remains the same,” she told media, adding that the consultancy at AAMCs was also free of charge.

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“The fee of any doctor is minimum Rs 200 [$3] in this area. If we include the expense for medicines, then the cost goes up to Rs 300 [about $5],” she said.

Afzal Khan, a doctor at the AAMC, said he sees at least 120 patients in a day.

“The benefits are for the patients who used to earlier go to hospitals and stand in long queues. They can now receive healthcare facilities in their own areas,” he said.

In the last four years, however, the New Delhi government has been able to establish less than 200 AAMCs as against its plan of a thousand.

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Shaleen Mitra, private secretary to New Delhi’s health minister Satyendra Jain, said acquiring land in the national capital for the construction of AAMCs has been the biggest challenge.

“Land has been one of the most critical aspects in achieving the target set up by the New Delhi government. Whatever land belongs to the state government has already been allotted to other agencies,” he told Al Jazeera.

Mitra said the AAP government is struggling because many of the approvals are still pending with the federal government. “But the government has decided to complete the target of 1,000 clinics by the end of this year.”

‘Little political will’

However, experts such as Mukhopadhyay, who is also an activist associated with the People’s Health Movement, feel there isn’t enough “political will” in India to address the issue of healthcare.

“Currently, there is very little political will from the government to spend on healthcare in general,” he said, though he conceded that the New Delhi government is making that investment.

New Delhi’s AAP government this year allocated Rs 6,729 crore [nearly $1bn] for the health sector, which was an impressive 12 percent of its annual budget, including over Rs 400 crore [$60m] for the AAMCs.

In stark contrast, the federal government spends around one percent of its Gross Domestic Product (GDP) on health. Neighbouring Nepal spends 2.3 percent of its gross domestic product (GDP) on health while it’s 2 percent in Sri Lanka.

“No other civilised country spends 1.15 percent of its GDP on health. It should be one-tenth of the government budget or at least 3.5 percent of the GDP,” said Mukhopadhyay.

Aljazeera