July 17, 2024
NEW DELHI – The single-floor pale yellow building, with its plaster peeling and moss growing on its walls, is easy to miss amid the multi-storey houses in Uttar Pradesh’s Mamura village on the fringes of India’s capital, New Delhi.
But for many poor and middle-class Indians in and around the village, this government-run health clinic, where services are free, is a prominent lifeline.
On July 15, 49-year-old Sidh Gopal, a daily-wage worker who works at a sports garment factory, was there to consult a doctor for a nagging pain in his ankle joints.
“We come here to save a few rupees,” said Mr Gopal, who earns around 10,000 rupees (S$160) each month, as he held on to his rusty bicycle in one hand and the iron and calcium tablets he had been prescribed in the other.
Such primary health centres, which are spread across the country and form the first point of healthcare access for many Indians, have, however, emerged as a flashpoint between the central and several state governments.
A recent decision by the central government to rename these clinics as Ayushman Arogya Mandirs has run into opposition from several states, especially those with a significant non-Hindu population.
The term “mandir” in Hindi refers to a temple or a Hindu place of worship. The move, which was proposed before the recently held general election, has been seen as yet another attempt by Prime Minister Narendra Modi’s Bharatiya Janata Party to seek Hindu support.
These Ayushman Arogya Mandirs now also have to bear the Sanskrit tag line, Arogyam Paramam Dhanam (health is the greatest wealth).
Run in partnership between the central government and governments of states where they are located, these clinics were earlier known as Ayushman Bharat – Health and Wellness Centres (AB-HWCs).
The clinics are meant to offer an expanded range of services that go beyond the usual maternal and child healthcare services that they have conventionally provided.
New envisaged services include care for non-communicable diseases, palliative and rehabilitative support, as well as emergency and trauma response. Services at these clinics, including medicine and diagnostics, are free and meant for all sections of society.
The north-eastern state of Meghalaya, where around three-quarters of the population practise Christianity, has rejected the name change because of anticipated public opposition.
“If you are asking me to convert or rename my state health and wellness centres into a mandir, then you are really asking for the moon, and I am not able to give it to you,” Dr Mazel Ampareen Lyngdoh, Meghalaya’s Minister for Health and Family Welfare, told The Straits Times.
“People will say how dare you, this is a health centre; this is not a mandir… Because our perception of the word ‘mandir’ means it is a place of worship. So, sorry, we cannot have that, and we will not have it,” she said.
“They (the central government) may send us a hundred other such advisories. But if the advisories are not suitable for the state, we don’t have to adopt them,” she added.
Under India’s federal structure, public health is listed under the “state list” in the Constitution, a classification that gives state governments “exclusive power” to legislate on matters included on this list.
Meghalaya’s opposition comes amid pushback from other Christian-dominated states, too. According to a June 26 report in The Indian Express newspaper, the north-eastern states of Mizoram and Nagaland, both of which are predominantly Christian, have also chosen not to go ahead with the rebranding.
As per a letter cited in the report, Mizoram said that renaming these clinics as mandirs “may foster adverse sentiments” towards the government among locals, and it sought to be exempted from the rebranding exercise.
It was in November 2023 that the federal Ministry of Health and Family Welfare had decided to rebrand the AB-HWCs, which consist of a network of around 170,000 such clinics across the country.
The government allocated a rebranding budget of 3,000 rupees for each centre, totalling roughly 500 million rupees for the entire country – money that critics pointed out could have instead been used to improve healthcare services provided by these clinics.
The government health centre in West Kameng district in the Indian state of Arunachal Pradesh. Such centres are now meant to be renamed as Ayushman Arogya Mandirs. PHOTO: NHSRCINDIA/X/THE STRAITS TIMES
Opposition has also come from locals in the federally governed union territory of Ladakh, where around 77 per cent of the population are Buddhist.
Mr Chering Dorjay, president of the Ladakh Buddhist Association, an apex body that represents the interests of Buddhists in the region, told ST it was strange to call these clinics “mandirs” or, for that matter, even “gompas” (the term used for Buddhist temples or monasteries).
“What’s the need to bring religion into health?” he asked.
Ms Aradhana Patnaik, mission director of the National Health Mission (NHM), did not respond to a set of questions from ST, including one on the reason behind the name change.
Locals at a yoga session being organised at the Ayushman Arogya Mandir government health centre in Dadra, Uttar Pradesh. PHOTO: HWC_UP/X/THE STRAITS TIMES
These clinics are run under the NHM programme, with funding jointly provided by the centre and the local state government. The centre, citing violation of NHM rules, has even held back funding for some opposition-ruled states that have chosen not to go ahead with the rebranding, including Punjab, West Bengal and Kerala.
The government in Kerala finally relented, issuing an order on June 26 to “add” the new name in an effort to secure overdue funding of reportedly more than 6 billion rupees from the centre.
The move to add a religious element to these universal establishments has also drawn criticism from public health activists. Mr Amulya Nidhi, the national co-convener of the People’s Health Movement – India, said the decision amounted to foisting the beliefs of one community on others.
“It doesn’t represent diversity and inclusion,” he told ST. “Today you have the term ‘mandir’. Tomorrow, what if you have photos of Hindu deities at these centres, then what?”
He added: “This is just a way to divert attention from the core issues in public health that need to be addressed. Instead, it is being portrayed as an achievement because the government feels doing so will bring it support from one specific (the Hindu) community.”
The Ayushman Arogya Mandir government health clinic at Mamura village in Noida. PHOTO: THE STRAITS TIMES
India still faces many public health challenges, including an infant mortality rate of 35.2 per 1,000 live births. A lack of staff, especially those adequately trained, has also hobbled services at these centres.
A government assessment of these centres in 18 states published in 2022 reported none of those visited in Bihar, Jharkhand and Uttar Pradesh was fully staffed, while less than half of the centres in another six states had the necessary staff.
It is such issues that need attention, noted Mr Nidhi. “Changing names will not achieve anything. Neither should it be counted as an achievement.”