Mohalla Clinics in Delhi

Provision of primary healthcare system has been a big challenge in Indian healthcare system. The need for a functioning primary healthcare system, which can be accessible within a reasonable geographical distance, has been recognised long back in 1970s. The Alma Ata declaration (1978) and India’s National Health Policy of 1983 and 2002 had accepted the importance of a functioning primary healthcare system.

Absence of a functioning primary healthcare system leads to large proportion of patients with common illness turning to secondary and tertiary care institutions for treatment. This results in overcrowding, long hours of wait, poor quality of service delivery, etc. Finally these patients end up in consulting non-qualified doctors or private doctors with out-of-pocket expenditure. The tertiary healthcare systems neither have time nor resources to handle every common illness.

Mohalla Clinics in Delhi

The Delhi government has come up with an innovative concept called Mohalla clinics. The concept was announced in the state budget for 2015-16, and the aim was to set up 500 such clinics in the first year. The Delhi government had allocated Rs. 209 crore for setting up of 500 such clinics. Each Mohalla clinic has about 50-60 sq meter built up area, in a plot of about 100-150 sq. meter, in a semi- permanent structure built with modern technology and latest design in an economical way.Each clinic will have a doctor, a nurse, a pharmacist, and a laboratory technician.At a later stage, the clinics would be provided with specialist doctors.

The clinic will take care of primary healthcare needs of people living within a kilometre of it.The services provided by them include outpatient consultations, immunisation, free medicines and diagnostics, family planning, referral and counselling services. The clinics timing will be 8 AM to 2 PM and some may operate in evening timings also. Each Mohalla clinic is linked to polyclinics (multi-speciality clinics) for logistical support and also for referral of patients who needs specialist care. The first such clinic was set up in July 2015 in Peeragarhi area of North-west Delhi. The cost to establish the clinic was Rs.20 lakh.

Advantages from Mohalla clinics

The concept of Mohalla clinic has a number of advantages.

• These clinics would increase the geographical access to healthcare services and reduces the travelling time and waiting time at the health facilities.
• Majority of patients feels uneasy in approaching big health facilities until they become seriously ill. The easy access provided by the Mohalla clinics would encourage patients to approach the clinics during early stage of the illness.
• Patients spend around 70% of the health expenditure on medicines and diagnostics. The provision of free medicines and 50 diagnostic services at free of cost would considerably reduce the healthcare expenditure for poor people. The easy access would also reduce the transportation cost and waiting time (opportunity cost of missing work).
• The rising burden of non-communicable diseases among poor would require lot of preventive care. The patients with hypertension and diabetes would require free medicines and also counselling services. The counselling services provided at Mohalla clinics would attract the patients to access those services. An effective referral service from these clinics would help the patients.
• The cost for setting up of such clinics would be much less than the cost for setting up of a secondary hospital.

Delhi has a number of reasons for success of such clinics. There is enough budgetary support from Delhi government. There is no difficulty in allocation of additional resources. Delhi has a big network of secondary and tertiary healthcare facilities to absolve the referral cases from Mohalla clinics. Delhi also has enough human resources in terms of availability of doctors, paramedical staff, and lab technicians. The high population density regions in Delhi would make such clinics viable and become popular.

Challenges

The one disadvantage with the concept of Mohalla clinics is they may not work in rural areas, which are low population density areas. The potential challenges in running of Mohalla clinics would be monitoring the working of 500 such clinics. There is a chance of abuse of drugs as they are easily accessible. Maintaining of medicine stocks at so many locations would be a challenge.

However, use of technologies like CCTV’s, IT solutions for inventory management, providing necessary skills to staff, use of biometric IDs to track patients, tie up with local NGos, etc. can help in facing the challenges.

The mohalla clinic concept is well designed than earlier healthcare interventions. The other state governments can study the concept of neighbourhood clinics and take up the pilot projects in Metros and other big urban areas.