Towards revamping health infrastructure under MCD

The COVID-19 pandemic has shed light on the unduly health infrastructure management of the
municipal corporation of Delhi. With the upcoming MCD elections, this factor should act as one
of the most determining criteria in terms of vote share.

The basis of contention

The National Capital Territory of Delhi is governed by three principal bodies. These include the
New Delhi Municipal Corporation (NDMC), the Delhi Cantonment Board (DCB), and the
Municipal Corporation of Delhi (MCD). Out of 70 assembly segments of Delhi, the MCD covers
68 areas. In this respect, the now-unified MCD can have superimposing responsibilities with the
Delhi government. While health dispensaries and smaller hospitals are under the jurisdiction of
MCD; the bigger hospitals and Aam Aadmi mohalla clinics are maintained by the Delhi
government.

Shortcomings under MCD

The pandemic has highlighted the shortcomings of healthcare infrastructure under MCD as one
existing within the state of despondency.

Firstly, the problem of staff crunch acts as a stumbling block in the establishment of an ideal
healthcare system. In Delhi, the majority of MCD dispensaries operate at less than half their
capacity. According to Dr. VK Monga, Chairman of the Public Health Committee at MCD,
“Since there is such an acute shortage of staff, MCD is managing doctor visits on alternate days.”
Consequently, newly-established municipal allopathic dispensaries in Issapur, Nangloi,
Najafgarh, and Nilothi, which have been built for more than Rs. 15 crores, still remain vacant. It
is noteworthy to state that even though they boosted staffing over the years, the MCD was able to
hire several doctors to fill open positions at the Ayurveda centers which the health ministry
developed in partnership with AYUSH. However, all of them were Unani specialists.

Secondly, several discrepancies have been found in maternity hospitals under the NDMC.
Problems like lack of staff, lack of canteen, unsanitary conditions, and technological malfunction
have demanded strict compliance of health infrastructure diligence. At NDMC-run Kasturba,
Hindu Rao, and Girdharilal hospitals, nursing staff began an indefinite strike in face of
non-payment of their salaries in November 2020. Moreover, due to merging projects, patients
suffer as they must jump over a sizable ditch near the main entrance to go to the emergency room
at Kasturba Hospital.

With regard to the lack of technical staff, Dr. Rohan Krishnan, a founding member of the
Federation of All India Medical Association, claims that the hiring exam held by the Delhi State
Commission and the Union Public Service Commission (UPSC) is the primary cause of open
vacancies in Delhi hospitals. The pan-India examination is only conducted for MBBS doctors;
senior resident doctors, MS, or MD doctors were not eligible to appear for the exam that took
place on July 17. This is why specialized doctors are in such less numbers in government
hospitals.

Moreover, MCD doctors are mostly hired on a contract basis rather than as regular employees,
including senior resident doctors and junior residents in Delhi. When it comes to focusing on
their careers, doctors find that the contractual structure of a job doesn't offer much. Naturally,
ad-hocism associated with the noble profession of healthcare work impinges upon their dignity
as well as reflects a human resource management deficit.

In January 2022, the NDMC-run Rajan Babu tuberculosis hospital was discovered to be unsafe
for human habitation. It is one of the biggest hospitals run by NDMC with 700 beds and 50
doctors. However, the hospital was still being run in a dilapidated state without paying heed to
the lives of patients, attendants, and staff. In response, it was stated that the corporation is
undergoing a financial crisis and this is why it has not been able to immediately start repairs.
This reflects the shortcomings in bringing forth a robust responsive system from the perspective
of safety concerns. Moreover, drug shortage, poor utilization of infrastructure, non-availability of
staff, and lack of diagnostic facilities ensure that the patients do not get proper treatment.

Lastly, despite the increase in dengue and chikungunya cases, the Municipal Corporation of
Delhi appears to have a severe shortage of fogging machines. An investigative report by
IndiaToday shows that on a ground level, people are mostly unaware of the use of fogging
machines. Furthermore, as per a report by the public health department, the corporation has run
out of insecticides used in anti-mosquito drives.

Greater cooperation
It is saddening to see that the Corporations, that are in charge of delivering secondary care in the
city, have been unable to establish an efficient structure to address issues in this area. Some of
the possible solutions are listed below.

The anti-dengue campaign run by the Delhi government can be effectively implemented with a
stronger role of the civic bodies. Additionally, the demand for handing over MCD hospitals
including Hindu Rao and Kasturba Gandhi to the Delhi government for better management must
be considered. A notion of shared infrastructure can also be adopted, which will play a
significant role in reducing the burden on Lok Nayak hospitals in Delhi. Regular visits must be
conducted to mark hospitals and dispensaries fit for work. The problem of ghost workers must be
addressed with caution by regular inspection of the attendance records of MCD. With the
unification of three MCDs, fund allocation is expected to improve. Greater priority thus must be
given to the health sector. With respect to specialized staff, State examinations must be regularly
held to intake more deserving health workers. Nevertheless, GCTD is making every effort to
boost the primary and secondary healthcare infrastructure. By remodeling and expanding the
already existing Delhi Govt hospitals, the government is working hard to increase the number of
hospital beds. Hence, Delhi should retain its image as the “health capital” of the country through
a strong liaison between the civic body and government. The upcoming elections must be a
promising factor in its making.