Namma Clinics: Many gaps to fill in a journey to provide health for all

HEALTH FOR ALL IN BENGALURU

DH Photo/ Prashanth HG

Anthony, a head-loader from the S K Garden area, sandwiched between Lalbagh and J C Road that belongs to the Chickpet assembly constituency, often suffers from body pain and headache.

“I have kept a stock of medicines. Whenever I get a headache or body pain I take them,” he says. Why is he self-medicating? He reveals that some days he does not get work and there are not enough earnings, so he cannot afford to spend much on getting prescriptions.

Aimed at serving people like Anthony, Namma Clinics, visualised as last-mile health service delivery systems focusing mostly on non-communicable diseases, were launched last February. Out of the planned 243 centres, as of today officially 225 Namma Clinics are functional across Bengaluru. These act as sub-centres for Primary Health Centres (PHC).

Staffed with a doctor, a paramedic, a nurse and a Group D employee, each Namma Clinic serves people for free by diagnosing basic issues and giving commonly needed medicines. For anything advanced, patients are referred to speciality government hospitals or nearby primary health centres.

But Anthony can’t go to Namma Clinic in his ward because his ward Sudhamanagar does not have one. He can go to other closeby PHCs in other wards or assembly constituencies, but it means sacrificing his working hours, which again affects his earning. Taking medicines over the counter from the pharmacy saves money for him. In his area, people walk towards a PHC located across K H Road in the Shantinagar constituency.

Ground reality

A ground check by DH revealed that most of the functional clinics had adequate infrastructure and staff. Every clinic has a waiting area, laboratory, medicine dispensing room, medical officers’ room, and a washroom.

Namma Clinics are open on all days except Sundays from 9 to 1.30 pm and 2 to 4.30 pm. Some of them such as the ones in Lower Palace Orchards, Malleshwaram, Subramanyanagar and Rajajinagar follow a different time schedule—6.45 am - 10.15 am and 4 pm 7.30 pm.

An Aadhar card is asked for identity purposes but it is not mandatory. Most Namma Clinics receive around 20-30 patients per day, all consulted, tested and treated for free. This decreases the patient load on PHCs.

Namma Clinic is supposed to conduct rapid tests for pregnancy, blood sugar, malaria, dengue, HIV, blood group, haemoglobin, hepatitis tests and more. Some of the labs did not conduct all of these, as the required reagents were not available, and sometimes because there was no need for them.

Some of the Namma Clinics had a stock of anti-rabies vaccines and antivenoms for emergencies. When they do not have a medicine, they write prescriptions and people can buy from medicals.

Although most of the Namma Clinics are at the ground level in most places, some do not have ramps to make them disabled-friendly. Most patients visiting Namma Clinics suffer from diabetes, thyroid and blood pressure issues, while common fever is another seasonal issue.

Sources say that 243 drugs were tendered but bidders came forward for only 30 medicines. About 50 medicines are supplied by Karnataka State Medical Supplies Corporation (KSMSCL), but for the rest of the medicines, the Namma Clinics have to either give prescriptions or refer the patients to other government facilities.

This is because the bidding prices during government tenders are kept very low. The price at which the state procures medicines has to be increased in order to get more bidders, say sources.

There was a shortage of doctors for Namma Clinics which is now sorted, say officials. When a doctor avails of leave, there is no spare doctor to replace him or her, and such situations are seen by people as

Though the BBMP website provides a list of Namma Clinics and locations, it is difficult to find their precise locations. In some areas, the residents, shopkeepers and chemists DH spoke to were not aware of their location or existence.

Activists highlight health gaps

Jancy, a member of Slum Mahila Sanghatane works in seven wards in Chamrajpet and Chickpet, says every home in her area in Chalavadipalya has people, especially senior citizens, suffering from blood pressure, thyroid or diabetes. They depend on PHCs, but PHCs do not have medicines for most of these. Even Jan Oushadhi shops do not have stock of most of these medicines.

PHCs should conduct surveys on such patients and keep stock of medicines, she feels. Writing to officials including the joint commissioner’s level has not helped.

She says the Namma Clinic inaugurated by the MLA has remained closed since then, even after media attention to the issue. She says doctors in PHCs say they can’t do much as one doctor handles two-three PHCs.

She says most slums have dog bite issues but PHCs do not have anti-rabies injections, so people are forced to go to Victoria Hospital or Kempegowda Institute of Medical Sciences (KIMS).

Most people in EWS sections are confused with the utility of multiple cards the government has issued, says R Manohar, the executive president of CARE, a non-government organisation. Some people do not know what is Ayushman Bharat card, others do not have a BPL card. All these people end up spending money on private clinics for health needs.

Many of them are hand-to-mouth people, they can’t go stand in the queue or visit Bangalore One centres to get cards or go to middlemen. A single window system that can tell them what is card useful when and where and issue the cards is needed, he adds.

Even during Covid, the government focused on awareness sessions in areas where middle-class people lived but neglected slums, he says. He identifies the language barrier and extra focus on online means as the mode of communication as the issues.

Prabhakar, a healthcare activist working in Rajindranagar slum, says people don’t trust the government-provided healthcare system. The reason: Namma Clinics have many shortcomings including doctors’ shortages, and ask people to buy medicines from outside.

‘Improvement of Namma Clinics an endeavour’

Out of 243 Namma Clinics, officially 18 clinics are yet to commence operations. Locations have been identified15 and three remain to be identified.

K V Thrilok Chandra, BBMP Special Commissioner for Health, says that the aim is to place Namma Clinics in the areas where economically weaker sections live, in order to reduce their health expenditure. The plan is to establish one Namma Clinic for every 20,000 people. When there is a PHC in a ward, the BBMP tries to balance it out by placing Namma Clinic at the other end of the ward.

“The programme has definitely helped reduce out-of-hand expenditure for needy people. Our endeavour is to further strengthen it,” he says, adding that regular feedback is sought from patients and the public in order to improve Namma Clinics.

“One of the requests from people was the time of the Namma Clinics should be extended beyond 4 pm. But since it is a Government of India programme, the funds come from 15th Finance Commission grants and the model is similar across India. A policy decision has to be taken by the central government,” says Trilok Chandra. He says the implementation requires extra funds and the issue has been conveyed to the concerned.