Why is Centre Threatening to Cut Health Funding to Punjab Over Mohalla Clinics?

Talking to The Quint, Punjab's Health Minister Balbir Singh dismissed the allegations, calling them 'misguided'.

Based on the MoU signed between the Centre and states, the state governments have to follow certain guidelines, including those related to branding, formulated by the Centre while running these clinics.

(Photo: Twitter/ @DaaruBaazMehta)

Irked over the alleged conversion of Ayushman Bharat health and wellness centres into Aam Aadmi clinics (popularly referred to as mohalla clinics), the Centre recently threatened the Punjab government that central funding for the National Health Mission would be slashed for the state.

In a strongly worded letter, the Ministry of Health and Family Welfare said it will cut off funding of nearly Rs 676.11 crore for enhancing health infrastructure "if the state continued to convert centrally funded Ayushman Bharat health and wellness centres into Aam Aadmi clinics".

So, what are Aam Aadmi clinics and what clauses has the Punjab government allegedly violated? Read on.

What are Aam Aadmi Clinics?

Aam Aadmi or mohalla clinics, which were launched in 2015 in New Delhi, are community health centres that provide a free basic package of necessary medical services, including prescription drugs, diagnostic tests, consultations etc.

These clinics have a doctor, a technician for downloading patients' Aadhaar card information, and a lab assistant for taking blood tests and giving out medications.

What Has the Centre Alleged?

The Ayushman Bharat health and wellness centres is formulated with 60:40 contribution ratio by the Centre and state, respectively. Based on the MoU signed between the Centre and states, the state governments have to follow certain guidelines, including those related to branding, formulated by the Centre while running these clinics. 

Official sources in the ministry told The Hindu that they conduct regular surveillance by checking geo-tagged pictures of Ayushman Bharat health and wellness centres, to make sure that the facades of the buildings are more or less standardised across states. 

The official told the newspaper that it was observed that the facades of health and wellness centres had been turned on their head, and were “rebranded as Aam Aadmi clinics with prominent pictures of Punjab Chief Minister Bhagwant Mann plastered all over them.”

The ministry in its reference manual for designing the health and wellness centres states that the state can have pictures, painted following the local art forms, on the facade of the building.

An official, however, told The Quint that none of that was being followed in Punjab’s case, adding that "while states such as Tamil Nadu, Kerala, and West Bengal are also not compliant when it comes to facade designs, they have not politicised the design as Punjab has done". 

The ministry has, therefore, set a deadline of 28 February for the Punjab government to restore the facade branding of all health and wellness centres in rural as well as urban areas.

How Many Centres Does Punjab Has?

According to the ministry, there are 2,488 sub health centres and 379 primary health centres in Punjab. Additionally, there are 162 urban primary health centres in the state that are eligible for upgradation and regular funding under the National Health Mission scheme.

The official said around 3,029 sub-health centres, primary health centres, and urban health centres have been converted into mohalla cinics in the state.

In financial year 2022-23, Punjab had been given an approval of Rs 1,114.57 crore under the National Health Mission. An amount of Rs 438.46 crore had already been released so far as the Centre’s share. Up to Rs 676.11 crore was yet to be released. 

Further, the state has been provided with an approval of Rs 401.12 crore under the 15th Finance Commission and Rs 145.62 crore under the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission for the financial year 2022-23. 

What has Punjab Said?

Punjab's Health Minister Dr Balbir Singh has dismissed the allegations, calling them 'misguided'.

"The Aam Aadmi clinics are, in fact, proving instrumental in providing quality healthcare in far-flung and remote areas. The facilities being provided at these centres are top-notch. Earlier, these were primary health centres – and they were in a bad condition with no doctors being available, and lack of medicines," he told The Quint.

He also dismissed allegations of misuse of funds. "Talking of funds, the Centre was supposed to give us Rs 668 crore as per the 60:40 contribution ratio mentioned in the MoU. But they have given us only Rs 438 crore. On the contrary, the Punjab government was supposed to spend Rs 445 crore, but we spent Rs 618 crore," he said.

"The Centre talks about cooperative federalism, but where is the cooperation here? In cooperation, there is dialogue, not threats, " he added.

"The 60:40 ratio is only on paper. The land on which these health and wellness centres have come up anyway belongs to the state government. The Centre's contribution is only around 25 percent maybe," he claimed.

He added that health is a state subject – and that the Centre should not interfere in that. 

What are the Controversies Surrounding the Clinics?

While mohalla clinics were initially made in existing sewa kendra buildings, the 400 mohalla clinics launched last month were opened in the already existing and running primary health centres and health sub centres across the state.

"The fact is that already existing government clinics, including some of which are totally dilapidated, have been given a cosmetic makeover at an inflated rates. Can a little bit of wall paint, false ceiling, and floor tiling provide better health facilities?” Akali Dal leader Bikram Singh Majithia had questioned.

Last month, in the run-up to the opening of these clinics, state health secretary Ajoy Sharma was virtually transferred on the eve of the launch event. Sources had said he had reportedly refused to use Rs 30 crore from funds of the health department for advertisements of these mohalla clinics in states other than Punjab. The Mann government received a lot of flak over the move. 

Moreover, doctors working under the department of rural development have alleged that they have been asked to shut down their clinics in the villages – and shift to mohalla clinics.