It took these two tragic deaths and the resultant public outrage for the Delhi Government to act. It issued show cause notices to the hospitals, it warned all hospitals against refusing admissions, it set Iimits to what private labs are charging for dengue blood tests and so on. But it was too little too late.
The official figures of dengue afflicted persons at 1800 plus are underestimates as everyone knows – as are the number of the people who have lost their lives. The official count is 15, but the Director of St. Stephen’s Hospital is on record that in his hospital alone, at least seven dengue deaths have taken place.
The question is, if the Government had acted in time, could the current dengue epidemic have been at least controlled, if not avoided? It is true that the AAP Government has been in office for just six months, certainly too short a time to deal with the multiple problems inherited from its predecessor regimes run by the Congress and the BJP, including the multiplicity of authorities. But unless it takes a more comprehensive view of the structural reasons behind the current public health crisis and acts accordingly, the worst is yet to come.
The first warnings came much earlier in the year around March when the officials of the National Vector Born Disease Control Programme had alerted the newly-elected Delhi Government of the possibilities of a bad Dengue outbreak based on their readings of the weather forecasts of the Meteorological department. These warnings were not taken seriously.
The key to dealing with dengue is in the preventive steps to be taken to eliminate as far as possible the source where the Aedes mosquito breeds: standing fresh water. The preparations should have started straight away and the systems been in place by June. In the context of the increase in population, unplanned city growth and extremely poor and deteriorating civic facilities in the capital, the task is obviously herculean. It requires the strengthening of public health services and the political will and prioritization to build a large social mobilization with the inclusion of RWAs, bhagidari samitis (which bring together government officers with citizens) and ordinary folk in a joint effort to clear all such sources. Sadly, this is not what happened.
The blame game between the Centre, the State and the Municipal Corporation of Delhi (MCD) even on the most minor of issues hijacked the agenda for health.
Today when the Delhi Health Minister orders “MCD workers to go house to house to ensure all stagnant water is treated”, it sounds like a joke, adding insult to the tragedy of illness and consequent loss of livelihood, affecting lakhs of Delhi’s citizens. Please also inform Delhi-ites, Mr. Health Minister, who are these “MCD workers” you are referring to? Are you not aware that the MCD services, once so robust, have been outsourced, privatized and the workforce contractualised? Who do you think is going to do the checks, Mr. Health Minister?
One of the crucial services provided by the MCD was of a set of trained personnel known as domestic breeding checkers (DBCs) who check breeding spots in house-to-house visits and use the appropriate larvae-killing insecticides. Today, the programme is in shambles. In spite of warnings, there has been no effort to enhance the number of DBCs (domestic breeding checkers). For example, in South Delhi, one of the badly affected regions, whereas requirement of such checkers is 2700, the sanctioned posts are only 1300, of which 1195 are in place. It is the same story in other corporations. According to senior officials, not only are the numbers of DBCs grossly inadequate, the main checking, in the absence of more rigorous training, is limited to checking water in coolers.
The other levels of service to ensure prevention are provided by Malaria Inspectors and Assistants Inspectors. Here again the shortfall is staggering. Out of a sanctioned strength of 1155 Malaria and Assistant Malaria Inspectors, only 416 are in place, around one third. At the same time, there has been little or no effort towards any kind of social mobilisations to beat the Dengue menace. Sending messages on mobile phones to people not to panic is not going to be half as effective as just organizing a huge effort to clean up the most notorious breeding places.
Officials in the know speak about the power of offenders, like the builder lobby, or those businesses situated in industrial areas. Construction sites are notorious for breeding grounds for mosquitoes. Officials say that although Bombay has bylaws that give the corporation the right to cancel licenses for building unless they fulfil conditions of the treatment of stagnant water, a given at any construction site, the builders lobby in Delhi has succeeded in sabotaging any such move as have those running businesses in industrial areas. Workers in these sectors are the most affected.
In spite of the AAP’s declared commitment to improving health services in the city, the focus seems to be on hospitals.The increased budgetary allocations are still, it would appear, at the realm of plans. On the ground, allocations to municipal corporations’ health services have seen severe shortfalls. In North Delhi, while the allocated amount was 117 crores, according to the Mayor of North Delhi, only 29 crores rupees have been released. The allocation itself is much less than the 157 crores allocated last year.
A recent estimate has further broken up allocations specifically for countering vector-borne diseases. It shows that the allocations have been reduced from 9 per cent of the total health budget in Delhi in 2012-2013 to just 4.8 per cent in 2015-2016. Moreover, what is puzzling is that in spite of the earlier experiences of dengue outbreaks in the capital, the Delhi Government itself slashed its assessment of the requirement of funds from the Centre from 260 crores in 2012-2013 to just 42 crores in 2015-2016. This shows that the Delhi Government itself was disinterested in taking the required steps to strengthen the public health system and therefore reduced its demand accordingly.
The role of the centre has been shockingly callous. It has been consistently denying the demands made by Delhi, whether it was the Congress UPA Government granting barely one third of the demand made by Delhi, or now the Modi Government, under whom the allocations have plummeted to an all-time low – from 50 crores in 2012-2013 to just 17 crores in 2015-2016. The Modi Government it would seem is still finding it difficult to digest its resounding defeat in the Delhi polls and is hellbent on making things difficult for the Delhi Government.
While the Delhi Government cannot escape its own responsibility for marginalizing such an important health service which could mean the difference between life and death, it is the central government driven by its narrow agendas which is mainly responsible.
Dengue is not new to Delhi, nor is a Dengue epidemic and deaths. But what is disturbing is that after every such outbreak, lessons are are quickly forgotten and recommendations made by experts buried deep. The reasons are structural going beyond the insensitivity of this or that leader or government. In the last few decades, an ideological framework has been developed which is geared towards replacing public health services with insurance-based health schemes. Everything is geared towards hospital-based insurance which benefits the private sector by transferring public funds for private profit while the patient’s needs often get forgotten. This model has not worked anywhere in the world. Yet, we are seeing governments in India led by the central government pushing insurance as the panacea for health system problems. The Delhi dengue epidemic has shown the folly of such a path.
Brinda Karat is a Politburo member of the CPI(M) and a former Member of the Rajya Sabha.