Changing Paradigm of Health Care: Understanding Contours of Delhi

Delhi changed in every aspect since 1912 and the common man experienced this transformation from a vantage point which is strictly and surely out of reach from the outside world. There are thousands of oral histories of the city of Delhi, regarding its evolution. Batra (2010) analyzed that initially old city was acknowledged only for the purpose of creating adequate physical separation between the two cities. The situation of Old Delhi was not improved lately and Hume (1936) wrote that there was a “two-fold problem of congestion, viz, congestion of people in houses and of houses on land...” When Delhi received a deluge of refugee immigrants from then West Pakistan, it grew much larger than its infrastructural capacities. That was the time when DDA took the charge for infrastructural development, but despite the fact that land was available for housing, a constant refrain about the shortage of land for residential purpose shows poor assessment of the DDA for housing the poor. While for the poor only 35 % of the target could be met, for the rich three times more than the planned houses were built (Qadeer 2005). Urban renewal through DDA was set as the approach to planning for redevelopment of the existing city. But the role of DDA in the renewal strategies was biased and benefiting the rich, rather than poor, as envisaged (Maitra 1991; Priya 1993; Hosagrahar 1999; Qadeer 2005).

From the ancient Mughal era till the contemporary global city, Delhi was always at center stage. It functioned like a growth pole and enacted magnificently to attract in-migrants from all over the country. From the beginning of the last century, its population trends got a momentum and in the later half it grew at a remarkable faster pace. In all these years its health care system evolved in different phases, which can be organized as following:

  • (a) Indigenous Practices of Health Care This was the phase of traditional, inherited, indigenous system of medicine in India. Ayurvedic and Unani Tibbia College and Hospital with a consideration of an historical institution in India with special reference to Ayurvedic and Unani medicine, initially started as ‘Madarsa Tibbia’ in 1889 by Haziq-Ul-Mulk Hakim Abdul Majeed Khan Saheb who shares the family history of over 250 years of prominent practice of same medical craft. Institutions’ foundation stone was laid down by H.E. Lord Hardinge (the then Viceroy of India) in 1916 and later it was inaugurated by Mahatma Gandhi in 1921 (Khan 2007).
  • (b) British Period and the era of Philanthropy in Health Care British brought allopathic medicine with them and it spread all over the country with British rule. The health care institutions were established with a philanthropic notion and to fortify British Viceregality. Hospitals like Victoria Zanana (now known as Kasturba Gandhi Hospital), Lady Hardinge Medical College for women, Irwin Hospital (now known as Lok Nayak Jai Parkash Hospital), Willingdon Hospital (now known as Dr. Ram Manohar Lohia Hospital), Silver Jubilee Hospital (now known as Rajan Babu TB Hospital) and American Army Base Hospital during World War II (now known as Safdarjung Hospital) were among major contribution of that era.
  • (c) Human Resource and the Super-Speciality Care Bhore Committee report (GOI 1946) reflected acute paucity of trained health personnel and just after independence, it recognized by the Directorate of Ministry of Health. As a result Sardar Vallabhbhai Patel Chest Institute came into existence in 1949.

Nehru’s dream of a center of excellence in medical science came true in 1952, when foundation stone of AIIMS was laid with the initiatives under Colombo Plan. Later in this phase, institutions like Gobind Ballabh Pant Hospital and Guru Teg Bahadur Hospital were also established to train more health personnel to meet the future need in the public sector. Since 1990 onwards, various public sector hospitals have been established in various parts of Delhi, some of which also cater super-specialty care to the general population.

(d) Transformation from Charitable Hospitals to Corporate Care During the Times of Privatization This was (is) the era when the hospitals earlier built with philanthropic motives were transforming into corporate care hospitals. Hospitals like, Mool Chand Khairati Ram, R.B. Seth Jessa Ram and B.L. Kapoor were established after independence by the refugee immigrants who were also having same kind of charitable hospitals on the other side of the border, on the land acquired by the government on concessional lease basis (Qureshi 2001). During the life time of the founders, hospitals were serving well with charity motives but later their family members did not carry the legacy and shifted the main motive from charity to profit making, while converting these hospitals to corporate care hospitals (ibid). In the same realm, Indraprastha Apollo Hospital was built on government land but later failed to serve the urban poor as it promised earlier. Guru Harkishan Hospital was the latest entrapment by private and commercial health care institutions after BL Kapoor Hospital.

Transformation of all these hospitals can be considered as a future challenge in the evolution of healthcare in Delhi. This challenge becomes more serious with the notion that currently all these hospitals are not basically treating the sick but selling the healthcare. In case of Delhi, it is very important to note that, when the health care provisioning is becoming a profit making venture and uses public funds for the same then the whole situation becomes more critical which affects a broad spectrum of ill and sick people, who need immediate attention.

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