The Delhi government’s ‘mohalla clinics’ scheme, which aims to provide better primary care coverage in the national capital, is proving to be “popular” with residents, offering “key advantage” to the beneficiaries, according to a report published in The Lancet journal.
The clinics opened as part of a flagship programme by the AAP government launched in July last year. The initiative is aimed at expanding the reach and range of health services in unserved and underserved areas such as slums, the report said.
In a unique model, all services — consultation, medicines, and diagnostic tests — are offered in one place and are free for people from all income groups, The Lancet said.
In existing state-run dispensaries and hospitals, people have to visit three different places for these services and make more than one trip, it said.
According to the report, doctors and paramedics are also overworked and absenteeism is high. To circumvent such problems, compensation for doctors and staff in mohalla clinics is linked to the number of patients they see.
“We get patients from nearby areas, about 100 to 120 patients every day. Earlier they would go to a government facility located far off or to private providers in the vicinity, spending a good amount of money in both cases,” said Ramesh Bansal, the doctor in charge of the Sultanpuri mohalla clinic.
There are 106 such clinics in Delhi and close to 1.5 million patients have visited them in the past year.
Delhi has a fragmented health system run by multiple state and central government agencies and municipal corporations, as well as a range of private providers.
The health system of the Delhi government alone has 36 hospitals (10,000 beds), 185 dispensaries and dozens of other facilities, catering for 33 million outpatient visits every year, the report said.
Four municipal corporations run their own networks of dispensaries. Yet many areas remain underserved, some facilities remain under used or poorly staffed as the different health systems are not inter-linked.
Although mohalla clinics have added another layer to the existing system, they offer key advantages, according to the journal.
“They provide an assured package of services, facilitate access to basic services, with potential for referral linkage, and make it all affordable by reducing indirect costs like travel and lost wages,” said Chandrakant Lahariya, a public health specialist who was involved in designing the concept.
He said the project could help address problems of unqualified providers and overcrowding at tertiary-care facilities.
Chandrakant Pandav, a community medicine expert at the All India Institute of Medical Sciences (AIIMS), noted that “a serious limitation is the focus on curative care and neglect of preventive and promotive care. Under pressure from populist politics, these clinics are ending up equating holistic health care with curative care.”
Pandav, however, feels preventive outreach services, linkage with existing health facilities, and monitoring and quality assurance of diagnostic services could help improve the services being provided by the clinics.
The high-level expert group on Universal Health Coverage established by the Central government had recommended in 2011 a substantial increase in public health financing to provide universal access to free primary care services including essential medicines and diagnostic tests.
“Mohalla clinics appear to be putting this strategy into operation. There is already a good case for scaling this up in Delhi and potentially in other Indian states because people seem to like these services,” said Robert Yates, Senior Fellow at Chatham House, London, UK, after a recent visit to a clinic in Delhi.
“Evidence from around the world shows that increasing access to publicly financed primary care is the best way to accelerate health coverage,” said Yates.
Although some states have studied the model and are keen to replicate it, scaling it up in Delhi to 1,000 clinics by the year-end has been caught up in a political dispute, the report said.