India does not spend even 2% of its GDP on public health. Though every government says that it wants to increase the spending, percentage-wise the spending has been decreasing. Maharashtra is a laggard as other states spend much more of their income on public health. It is in this context that the Shinde-Fadnavis government’s decision to set up at least one Balasaheb Thackeray Aapla Davakhana in every one of the 227 municipal wards in Mumbai should be seen. Of course, it is an attempt to influence the voters, with municipal elections round the corner. If newspaper reports are to be believed, already 50 clinics have started functioning from October 2. The scheme is modelled after the mohalla clinics which the Aam Aadmi Party government started in Delhi in 2015. It is one of its flagship programmes, which has been hailed by health experts, the World Health Organization and the medical journal The Lancet.
There is a lot to commend mohalla clinics for. They provide primary healthcare, including medical consultation, medicines and diagnostics, to the people at their doorsteps. Most of the services are either free or low-cost. Most conditions can be diagnosed by a good doctor and patients can be given generic medicines, which are considerably cheaper than branded ones while being equally effective. Services of specialist doctors are provided on designated days.
The number of people availing of the benefits of the clinics has been increasing by leaps and bounds. The government also makes use of private doctors to man such clinics. As a result, the pressure on secondary and tertiary health facilities has been reducing. There is no need for a patient of malaria or diphtheria to go to a super speciality hospital like the KEM Hospital in Mumbai or the All India Institute of Medical Sciences in Delhi. Also, most common diseases can be treated by doctors with a basic qualification like the MBBS. To drive home the point further, no cardiac surgeon is necessary for a mammary incision. In India, one of the main reasons for becoming a pauper is the enormous cost involved in medical treatment. If a middle class or a lower middle class person, forget the poor, has to treat himself for a serious medical condition like cancer, he is often forced to sell his property and, perchance, the person dies, his family is left in penury. The government should not leave such persons to the care of private doctors and hospitals, which are profit-driven. The government should take care of them. Hopefully, the BT Aapla Davakhanas that will spring up in Mumbai will mark a new beginning in the city’s public health services.
Cleanliness a way of life in Indore
It is no mean achievement that Indore in Madhya Pradesh has been chosen as the cleanest city in the country. It won this position when only 73 cities and towns vied with one another for this distinction six years ago. In 2022, as many as 4,355 towns and cities competed for this honour which remained with Indore for the sixth consecutive term. Of course, the credit would go to the Indore Municipal Corporation but could the corporation alone have achieved it? Ideally, the credit should go to the whole population of Indore which made it a prestige to keep its city the cleanest in the country. Indore had to compete with cities which had greater resources like New Delhi and newer ones like Chandigarh and Bhubaneswar. Started in the wake of the Modi government’s Swatch Bharat Abhiyan, the annual Swachh Survekshan (all-India Cleanliness Survey) has become more and more competitive. Every city and town wants to improve its ranking in the successive surveys. The second and third positions among the cleanest cities were won by Surat and Navi Mumbai.
While Indore’s performance is exceptional, it is in line with the record of Madhya Pradesh. Among the states with more than 100 urban local bodies (ULBs), MP ranks first with Chhattisgarh, once part of MP, and Maharashtra getting the second and third positions. Among the states with less than 100 ULBs, Tripura, Jharkhand and Uttarakhand won the first three positions. Maharashtra won another recognition in the category of towns with less than one lakh population when Panchgani was put at the top. Neighbouring Gujarat’s Ahmedabad was declared as the “cleanest mega city” with a population of more than 40 lakh. A foolproof system to judge the cities is now in vogue and it is totally electronic. Significantly, states like Kerala, Tamil Nadu and Himachal Pradesh which are at the top on several other indices like literacy were nowhere in the reckoning. The beauty of the survey is that it reminds the cities to improve their cleanliness.
