Decongest hospitals with 'Mohalla Clinics'

Mohalla Clinics of Delhi are arguably one of the most visible primary healthcare initiatives by an Indian state. These clinics, by providing free and assured access to quality health services (including medicines) to the poorest and underserved population, have the potential to decongest hospitals and reduce expenditure in health services.

Initially, the Delhi government had faced challenges in establishing the target numbers of clinics due to reasons such as sub-optimal advanced planning, lack of coordination among agencies and political differences. With most of these issues being addressed now, the clinics are performing well and meeting the stated objectives, with nearly three million people having availed services at 100-odd clinics in the last 12 months.

National and international health experts have applauded these clinics for design and objective as well as for its cost effective approach to make progress towards universal health coverage. Understandably, the elected leaders of several states and a few urban local bodies (ULBs) have shown interest in adopting the model.

The most recent addition to the list is Greater Hyderabad Municipal Corporation (GHMC). After attending a conclave in New Delhi, the officials of GHMC visited a few Mohalla Clinics and interacted with residents in the localities.

Soon, the GHMC announced its intention to set up clinics on similar concept in Hyderabad, tentatively named “Basthi Davakhana’ (or Community Clinics). It proposed to set them up in slums and colonies with population of more than 5,000.
In urban India, with nearly four-fifth of all patients attending the private provider for outpatient consultations, strengthening primary healthcare services is a felt need in every city.

First and foremost, clarity on the goals to be achieved by the proposed facilities and value addition over the existing health facilities has to be an important consideration. Facilities with a new name instead of dispensaries and polyclinics could be politically appealing, yet may not serve the purpose.

The value addition could be: (a) to prioritise the underserved areas and population; (b) strengthening and establishing functioning referral linkages with next level of facilities; and, (c) harmonisation of services between different agencies (including state government) and a strong linkage with the proposed Urban-Primary Health Centres (U-PHCs) under the National Urban Health Mission.

Though more attention could be on slums, the Mohalla Clinics should be established to meet the primary healthcare needs of all sections of the population. If these clinics are set up in poor localities only, there might be perception of poor quality services.

Prior to selecting locations and arriving on required numbers, a detailed mapping of health facilities (run by any agency) and gap analysis (available facilities and services against required) should be completed. The facilities should go beyond curative services and also offer a range of population health services, including vaccination, screening for non-communicable diseases, prevention and control of seasonal diseases as part of the assured package.

Roadmap for success
A roadmap-cum-operational plan with timelines, budget and role and responsibility assigned among stakeholders has to be developed, in consultation with key stakeholder, and approved by highest level of authorities in urban civic bodies. This would be absolutely needed to achieve the clinics’ success, sustainability and desired accountability.

A likely challenge in the execution of this initiative could be insufficient financial capacity of the local bodies. There would always be shortage of funds for new initiatives and this is where commitment from top leadership would come to play in garnering resources, for an important initiative. An agreed roadmap and operational plan would be a useful tool to advocate more financial resources.

Second, no single intervention, irrespective of its popularity and scale, is enough to improve healthcare, to the extent desired and the proposed Clinics’ have to be accompanied by supplementary reforms, to make a difference.

The interest in Mohalla Clinics of Delhi, by many states and ULBs, highlights the emerging healthcare needs of a rapidly increasing urban population. However, despite explicit interest by many states, none translated the intentions into action.
So, the next steps of GHMC on the ‘Basthi Davakhana’, would be worth watching. If implemented well, these could influence the future of innovations in urban health service and accelerate progress towards universal health coverage in India.

(The writer is a leading public policy expert based in New Delhi)

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