Delhi’s Mohalla Clinics Bring Affordable Healthcare Closer To People’s Homes
Primary healthcare in India has been suffering from a lack of funding, staff, and infrastructure.
It’s a hot Saturday morning in Delhi and the lane outside a mohalla clinic in Panchsheel Vihar is already teeming with patients and their relatives. Panchsheel Vihar is an unauthorised colony in South Delhi, mostly occupied by low to medium level income families. As I approached the clinic, a three-room space, I met Rani, aged 18 years, who was also visiting the clinic. Rani had been suffering from irregular menstrual cycle and was here to consult the “lady doctor”. For her, this clinic and her doctor was more approachable than the closest government multi-specialty hospital located almost 4km away in Malviya Nagar. She prefers to come here as it is hassle-free (saves her the waiting time necessary at a big hospital) as well as cost-free (some drugs and tests are offered without any cost). She was hopeful that her problem would be solved at the clinic and she wouldn’t be “sent” to the “bada haspatal” (big hospital).
The Arvind Kejriwal government had come to power three years ago with a popular mandate and on the promise of working towards social justice and providing basic services to all. Health has been a priority for the government, with one of the highest allocations made for the sector (12 per cent for 2018-19) in all its budgets. The Aam Aadmi Party government, with a vision of providing quality and affordable healthcare to all, had started the concept of mohalla clinics (also called “Aam Aadmi clinics”). Apart from the routine outpatient department (OPD), these neighbourhood clinics provide immunisation to children, have a DOTS centre for treating tuberculosis, offer counselling on male sterilisation, assist with pregnancy related issues and so on. The clinics offer 110 essential drugs and 212 diagnostic tests to people free of cost.
The underlying idea for mohalla clinics is to bring diagnosis and treatment for simple ailments to the doorstep and reduce the pressure on tertiary care and multi-specialty hospitals. By treating minor ailments outside hospitals, these clinics are expected to free up doctors at specialty care hospitals to focus on complex diseases and surgeries. Thus, the Delhi government has established a three-tier healthcare structure based on primary, secondary, and tertiary healthcare. For immediate consultation in case of minor ailments, there is the mohalla clinic. For further diagnosis and treatment, there are polyclinics. The third tier for surgeries and treatment is the existing multi-specialty hospitals.
The first mohalla clinic of Delhi was inaugurated on 19 July 2015 at Peeragarhi area of West Delhi. While the government has not managed to achieve its target of opening 1,000 clinics by the end of 2016, the 160 operational clinics are functioning at full capacity. The government, however, once again promised expansion of mohalla clinics in its recent budget with an allocation of a whopping Rs 403 crore.
Dr Sukhbir Kaur, consultation doctor at the Panchsheel Vihar Clinic says, “since I have been working in the locality for almost three years now, I have built a rapport with the people here and thus they prefer to come here. On most days we work beyond closing hours as there is a huge line of people and I personally don’t want to turn someone back who has come to me with hope”.
Doctors like Kaur are private practitioners who have been appointed as consultants after an interview, and their wages are tied to the number of patients they attend to. For tests, private laboratories have been empanelled to conduct a range of diagnostic tests free of cost. The government compensates them for it. The doctor gets Rs 30 per patient, helper Rs 8 per patient, and sweeper Rs 2 per patient. Patients are examined using an internet-connected electronic tablet-based protocol and medicines are prescribed and dispensed by the doctor. The biometric listing of patients is maintained along with a list of medicines dispensed on a digital cloud and made available to the government. This ensures maintenance of a permanent record, which could be a source of data for further diagnosis in case the patient is referred to a specialist. Patients can typically collect their medicines over the counter at the clinic, although the government has started experimenting with vending machines on a pilot basis. The ambulance is available on a call basis.
The clinic we visited was one of the many being run out of a rented premises. It was a small three-room space staffed by a doctor, a nurse, a pharmacist, and a laboratory technician. Usha, who was at the clinic to collect the blood test report for her five-year-old said the clinic had been a boon to her family. She and her husband are construction workers and can hardly afford to miss their working hours to take their children to hospitals.
Earlier, one of them had to sacrifice a day’s precious wage every time their children had even a minor ailment. Now, with the clinic in the vicinity and with longer OPD hours (clinics work 9am to 2pm, Monday to Saturday), she can easily bring them to the clinic on the way to work.
Another important impact of such clinics has been the weeding out of unqualified medical practitioners and quacks. With quality medical care available for free, people have stopped visiting other clinics and centres.
In a country like ours, where primary healthcare has been suffering from a lack of funding, staff, and infrastructure, Delhi’s mohalla clinics present a standalone example of success in delivering quality, affordable healthcare. The recent state budget has once again given the people of the city hope for more such clinics. One can only hope that promises will be delivered upon and this initiative will not get lost in the political muddle.