As per the plans of the Delhi government, the state should have had 1,000 mohalla
or community clinics in place by end-2016. However, only one-tenth the promised number had come up by the end of last year, despite health
being at the top of the agenda of the elected state government.
clinics aim to make select health
services available and accessible to poor and underserved communities. As per an official report released in August 2016, nearly 800,000 people availed themselves of the health
services, and 43,000 pathological tests were conducted over a period of five months. During the dengue and chikungunya outbreak in Delhi in September-November 2016, laboratory tests were done and doctors examined people with symptoms at mohalla
clinics, contributing to less crowding and panic at hospitals.
The concept has received acceptance across the political spectrum and several states (Punjab, Maharashtra, Gujarat and Karnataka, for example) and a few municipal corporations (Pune) have shown interest in launching a variant of these clinics.
This is not surprising, as primary health
care infrastructure is largely non-existent in urban India. People have to go to big hospitals, which are usually overcrowded and far from their homes. They have to wait long hours, losing their daily wages, with no assurance of health
care services. Alternatively, people delay seeking health
care, which leads to a worsening of their health
To address this, the Union government in 2013 launched the National Urban Health
Mission (NUHM), which aims to have a doctor at an urban primary health
centre (U-PHC) for every 50,000 people. In contrast, mohalla
clinics aim to provide a doctor and a slightly lower range of services for every 10,000 people.
Until now, the lowest contact point for people to see a doctor in the health
system was the 370-odd allopathic dispensaries run by the Delhi government. However, while these dispensaries have good infrastructure, utilisation of their services has remained low owing to lack of clarity on the scope of service provision, lack of human resources, and other factors.
While the design of mohalla
clinics is cost-effective, their success will depend on effective implementation. Moreover, having been set up within the community with the availability of a qualified doctor, these clinics could help in eliminating unqualified practitioners. These also provide an opportunity for community participation in health
Mohalla clinics in Delhi have been set up through a number of innovative approaches, including doctors on contract on a “fee-for-service” basis, use of rented premises, and flexible and variable clinic timings to ensure convenience. However, in recent months, there have been hiccups in setting up additional clinics, such as delays in land allotment, official approval procedures, and infighting between the Delhi government and municipal corporations over land.
While the mohalla clinics initiative had two important ingredients for success — political will and financial resources — apparently not enough was done for timely implementation. There could have been improvements in three areas.
First, no operational plan was prepared for almost a year. Had there been a road map from the beginning, the challenges might have been identified, understood and addressed. A few independent technical experts believe that the target of setting up 1,000 mohalla clinics in such a short period was extremely ambitious, unrealistic and reflected political naiveté and disrespect for processes.
Second, this was projected as a flagship state government scheme. Engagement with other stakeholders, such as municipal corporations, was not thought through. Health
facilities run by the state government in Delhi serve nearly half of all people who go to any public health
facility. However, allotment of land is controlled by a separate body, and getting land for these clinics had become a tug of war. The core concept of mohalla
clinics as an efficient referral linkage to the next level of health
facility works best when there is coordination among all agencies providing health
services. Engagement with both health
stakeholders is essential for success.
Third, though political parties would like to continue to be in power forever, the reality is different; following a change in government, the flagship initiatives of the previous government tend to suffer. The current government should engage with other political parties and seek to build a consensus in order to ensure political as well as financial sustainability for the programme.
Though the timeline for the setting up of these clinics has been shifted, lessons need to be learnt. The government should engage with all stakeholders; develop a detailed road map and operational blueprint, shared and agreed with stakeholders; and explore mechanisms for political sustainability.
clinics have generated hope among the poorest of gaining access to quality health
care, and have the potential to improve the way people seek health
services. Above all, the success of the initiative in Delhi could focus attention on restructuring and revamping primary health
care across states. That would be the real contribution of mohalla
clinics to India’s health
The writer is a public health expert based in New Delhi. The views are personal.
Published with permission from Ideas For India (www.ideasforindia.in
), an economics and policy portal