Delhi's deepening health crisis

A new report by the NGO Praja Foundation highlights the worsening health crisis in Delhi, where increases in deaths from circulatory diseases, respiratory conditions, hypertension, and tuberculosis are raising significant concerns.

Released on Thursday, the report reveals alarming statistics, including a 109 per cent rise in hypertension-related deaths, from 1,962 in 2014 to 4,102 in 2023, and a similar doubling in diarrhoea-related deaths, which have risen from 146 to 292 over the same period.

Additionally, the report notes a decrease in the allocation of the overall state health budget, which has fallen from 3 per cent in 2023-24 to 2.5 per cent in 2024-25. In 2024-25, 12 per cent (Rs 2,061 crore) of the Municipal Corporation of Delhi's (MCD) total budget and 11 per cent of the overall state budget were allocated to the health sector.

Respiratory diseases and air pollution

Delhi's air quality has had a devastating impact on residents' health. Monthly trends over the past five years indicate that November and December consistently register the worst air quality index (AQI) levels.

Apart from 2020, the annual average AQI has been classified as ‘poor’ (200-300) for the past eight years. In 2022, during the monsoon months of July and August, the AQI was 83 and 90 respectively, but in 2023, only the month of July had a satisfactory AQI of 76.

In 2023, the worst AQI of the year was recorded at 384 in November, driving a 29 per cent increase in registered respiratory diseases between 2022 and 2023. Deaths from respiratory conditions rose by 19 per cent in the same period, with tuberculosis and lower respiratory diseases contributing to 25 per cent and 21 per cent of these deaths, respectively.

Maternal and infant health

In 2017-18, the maternal mortality rate in Delhi was 193 deaths per 100,000 live births. By 2023-24, this figure has risen to 250 deaths per 100,000 live births.

The neonatal mortality rate has also worsened, rising from 12 deaths per 1,000 live births in 2017-18 to 23 deaths per 1,000 live births in 2023-24.

Similarly, the infant mortality rate has seen a significant increase. In 2017-18, there were 19 infant deaths (under one year of age) per 1,000 live births, which has now risen to 32 infant deaths per 1,000 live births in 2023-24.

Additionally, there has been a concerning decline in the number of pregnant women registering for antenatal care, with a 37 per cent decrease between 2019-20 and 2023-24. Despite this, 87 per cent of all registered women in Delhi received four or more antenatal checkups in 2023-24.

The number of children reported as severely acute malnourished has decreased by 16 per cent, from 3,675 in 2019-20 to 3,099 in 2022-23. However, a majority of malnutrition-related deaths occurred in the 0-4 years age group in 2023, with 80 per cent of all such deaths taking place within this group.

Rising deaths and data gaps

The total number of deaths in Delhi has also risen, with 88,628 recorded in 2023, an increase of 9 per cent from 81,630 in 2022. The data on the causes of death (COD), which tracks specific ailments responsible for fatalities, increased by 10 per cent, from 74,592 in 2014 to 88,628 in 2023.  

However, this figure only reflects institutionalised deaths, with no COD data available for non-institutional deaths, which make up around 33 per cent of total deaths. In 2023, 67 per cent of registered deaths were institutional, and detailed cause-of-death data was available for these cases.

A concerning trend observed between 2014 and 2023 is the higher number of male deaths compared to female deaths. In 2023, out of the 88,628 institutional deaths, 62 per cent (55,146) were male.

Healthcare staff shortages

A critical issue facing Delhi’s healthcare system is the severe shortage of staff. As of 31 December 2023, Delhi’s government hospitals and dispensaries were operating with a 32 per cent vacancy rate. This is particularly concerning given that Delhi’s hospitals serve not only the city's residents but also patients from surrounding states.

Additionally, there was a 67 per cent shortage of lecturers in medical colleges in 2023, and the vacancy rate for paramedical staff has risen from 36 per cent in 2018 to 43 per cent in 2023.

The situation is equally dire in the Aam Aadmi Mohalla Clinics (AAMCs), which were once considered a cornerstone of the ruling Aam Aadmi Party’s healthcare reforms.

These clinics are staffed by contracted, part-time empanelled doctors. As of 31 March 2024, vacancies were reported in various roles: 8 per cent for doctors, 4 per cent for pharmacists, 5 per cent for assistants, and 14 per cent for multi-task workers. However, these vacancies refer to empanelled positions, not permanent roles, as per data provided by the directorate-general of health, Delhi government.

Health statistics and infrastructure gaps

According to the 'Urban and Regional Development Plans Formulation and Implementation Guidelines (URDPFI)' guidelines, which mandate one dispensary for every 15,000 people, Delhi should have 1,095 dispensaries. However, in 2023, the city had only 983 government dispensaries and clinics, 14 per cent short of the required number. This shortage exacerbates the challenges facing the city’s healthcare system, as demand for services grows with the rising number of health issues.

The Praja Foundation report also highlights significant gaps in healthcare data, with many government hospitals and dispensaries failing to provide complete information over the years.

These inconsistencies, coupled with a weak and largely non-functional health management information system (HMIS), have created obstacles in tracking diseases and deaths effectively. The fragmented healthcare system, managed by central, state, and local authorities, further complicates data collection and analysis.

Issues in data collection and reporting

The Praja Foundation gathered data from various government institutions through the Right to Information (RTI) Act. The analysis, covering the period from January 2014 to December 2021, shows that many hospitals and dispensaries failed to submit complete data for several months. This lack of reliable, real-time information, particularly from primary healthcare facilities, poses a significant challenge in managing the spread of diseases and formulating effective public health policies.

Praja Foundation CEO Milind Mhaske stressed the importance of centralising healthcare data, saying, “The absence of real-time data on sensitive diseases registered in Delhi, especially in primary healthcare facilities, leads to issues in mapping the spread of diseases and formulating effective policies to tackle them.”

The fragmented nature of healthcare governance in Delhi, with different authorities managing different aspects, further hampers the collection and accessibility of data. Centralising this information into a single, accessible repository is essential to address these challenges effectively.

The report highlights a pressing need for urgent reforms in Delhi’s healthcare sector. The rising deaths, especially from preventable diseases linked to pollution, the growing staff shortages, and the data collection issues all point to a healthcare system under strain.