Mohalla Clinic: A giant leap for healthcare
The Aam Aadmi Party (AAP) government has managed to carve a new road for healthcare in India, its ambitious mohalla clinic initiative is making noise globally as an alternative to deteriorating primary healthcare facilities, being much more affordable and easily accessible
Shibu Kumar Tripathi Delhi
In a small two-room setup on the ground floor of a double-storied building in Rajpur Khurd, Chattarpur, Delhi, a queue of 20-odd men, women and children await their turns, slowly filtering into the room to the metronome of a buzzer. Inside, Dr Kuljeet Kaur Bhatia patiently listens to the complaints of the visitors, conducts tests and prescribes medicines, managing the daily bustle in one of the 105 Aam Aadmi Mohalla Clinics (AAMC) opened by the Delhi government throughout the National Capital Territory (NCT). AAMC, a pioneer pilot health services project, is making news globally. The Department of Health and Family Welfare is successfully running the show from behind the scenes with a team of experts in the Delhi Secretariat managing all the logistics, supplies and digital records of patients for the clinics.
With plans to expand the reach and range of healthcare, the pilot project aims to establish clinics that provide medical consultation, conduct tests and prescribe medicine free to patients in the underserved and un-served regions of Delhi. With its success so far, the plan has been extended. The government hopes to open 1,000 such clinics by the end of the year. Newly released data indicates that over eight lakh patients have been treated in just four months.
Healthcare facilities in India operate at three levels: primary health centres, secondary health centres and tertiary health centres. Mohalla clinics are slowly gaining momentum over primary healthcare facilities, which are in a bad shape nationally. These clinics are taking some of the burden off of district hospitals, which lack proper equipment and suffer from staff shortages. The idea of the mohalla clinic is that each one must cover a population of 10,000 people. Sangeeta Devi, who was in the clinic to get her son, Aditya, checked for ear ache, said, “We were earlier planning to go to AIIMS, but it would take an entire day to just get registered and get the token and then get him checked. These clinics have brought the hospital to our doorsteps and it is easy for us to directly meet the doctor in the morning hours.”
The revamped three-tier system works with mohalla clinics at the basic level, followed by polyclinics at the secondary level and super-specialty hospitals at the tertiary level. The patients receive treatment and consultation free from the polyclinics. AAP has started over 20 polyclinics in the NCT and plans to have 150 by the end of 2016. The AAP government made its intentions clear in this year’s budget with an allocation of Rs 4,787 crore, roughly 16 percent of the total budget for the health sector, of which Rs 125 crore is earmarked for mohalla clinics. The figures are very high compared to those of the Union budget, which had allocated just 1.5 percent to the health sector in FY 2016-17.
The clinics function six hours a day between 8 am and 2 pm, which can extend to over eight hours, based on the number of patients. They see 100-130 patients every day. Dr Bhatia said, “In July the number of patients coming to the clinics ranged from 75 to 80. However, in August with the monsoons setting in this number has gone up to over 130 every day.”
The clinics are a one-stop solution for numerous diseases, with over 50 tests being conducted at one place. Manoj, who was experiencing fever and rashes, reached the mohalla clinic and was told to get a blood test, which was done in the clinic. The report came within a day. Though it indicated everything was normal, the doctor pointed out that his haemoglobin level was low. Talking about the benefits of performing the tests at the same place, Dr Bhatia said, “We conduct all sorts of tests in the clinics, including blood tests, stool tests, urine tests and others. The samples are then sent to the labs for proper diagnosis and reports are received within a day.”
All the records are then entered into a tablet provided by the government which runs on cloud computing. These records are accessed through the names, photographs and phone numbers of the patients to glean their medical history. The tablet is operated by a helper from the handful in the AAMC and is digitally secured in a server. The patients are given a receipt for the prescription generated by the software along with the medicine. The medical supplies for the mohalla clinics are being handled by government dispensaries throughout the city. The compounder said, “We send a message either through Whatsapp or through mail and the resupply is done within four hours.”
With the introduction of the medicine-vending machine at the Todapur mohalla clinic, the government is planning to make the system automated and reduce paperwork for doctors. Officials in the department of health said that, “The medicines were earlier distributed by either the doctors or helpers on the prescription of the doctor, but now patients can get the medicine themselves from the machine which will be flushed out once instructions are sent from the tablets.”
The pilot project is being run by doctors who have been recruited through a separate process and are paid Rs 30 for every patient. Officials say that this is a good idea as doctors will make the money on the number of patients they see, which will help in getting rid of the lethargic attitude prevalent in government hospitals. The doctors are trained in workshops following their recruitment by experts from AIIMS and super-speciality private hospitals.
Mohalla clinics have started gaining global momentum and the model is being praised in Europe and America. Despite the buzz around it, people are finding it difficult to locate these clinics in the city, majorly because the government has not disseminated sufficient information. Most of these clinics are being run in rented apartments which are difficult to pinpoint in emergency situations. In many mohalla clinics, the doctor is solely responsible for feeding the data into the cloud system, which consumes quite a bit of time along with the duty of attending to the patients. Doctors also said that there is lack of training in managing the online system, something the government needs to work on.
To seize the opportunity, the government is now in plans to start mohalla clinics in commercial hubs as well. The initial plan is to start clinics at Nehru Place, Bhikaji Cama Place, and Netaji Subhas Place. The government is moving ahead with plans to open nearly 300 mohalla clinics in government schools to provide medical facilities directly to children. However, there are some issues such as the fact that parents have started rallying against the idea of starting clinics inside school premises that will treat the general public. Parents fear for the safety of their children.
Mohalla clinics have been a success so far for a debutant government which is facing flak from all around. If implemented fully in the given time-frame, experts say it will be a permanent solution to the inadequate primary healthcare facilities in India.