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Are Delhi’s Mohalla Clinics A Successful Primary Health Care Model? Let’s Take A Look.

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Ashu, 22, runs a tea stall in Munirka. He and his family have been visiting the Mohalla Clinic for the past two years and are thoroughly satisfied with its performance. He is a patient of diabetes and is the sole bread earner in his family of three kids and wife. Earlier, visiting a government hospital for getting his sugar levels tested, buying medicines and running his shop side by side was very stressful for him, so he avoided visiting the doctor unless it was urgent.

Ever since a Mohalla Clinic opened in his neighbourhood, he’s been going for regular check-ups. Since he gets his medicines free of cost and doesn’t spend on travelling to the hospital either, he’s been able to save the money for his family, which he would have otherwise spent on commuting and buying medicines.

CM Arvind Kejriwal inaugurated about 152 clinics on one single day on January 5th, 2020. Image source: Amar Ujala

Aam Aadmi Mohalla Clinics have been the flagship programme of the incumbent AAP government in Delhi. Though the promised target by the government during the present term was to establish 1000 MCs, the programme has been laggard in implementation, reaching a 50% mark barely, with CM Arvind Kejriwal inaugurating 152 clinics on one single day on January 5th, 2020, to reach a final tally of 450. Nevertheless, the boost to primary healthcare in Delhi has been significant, much appreciated by all. It would surely be one of the significant achievements to influence the electorate in the forthcoming elections on February 8th.

Post-independence, India, along with its freedom, inherited a crippling economy, burgeoning population and a deep healthcare crisis. To resolve this issue, a ‘Bhore Committee– The Health Survey and Development Committee’, chaired by Sir Joseph Bhore, was constituted to probe into the healthcare system of India, integrating preventive and curative services for the public. Based on the recommendations of this committee and through extensive research, experimentation and understanding, a healthcare model was strategized which involved ground workers, Primary Health Centres (PHC), Tertiary Care Centres and Urban Hospitals.

With such profound genesis, India has come a long way in strengthening public health by establishing high-tech diagnostic labs, facilitating public healthcare, eradication of diseases, decreasing infant mortality rate and giving prime importance to maternity issues through socio-economic development.

However, at PHCs, India has an acute human resource crunch with deficiency of 6,00,000 allopathic doctors and 2 million nurses. This is against the WHO norms in which, the doctor to patient ratio in a country should be 1:1000 while in India, the prevalent ratio is 1:1499.

Article 47 of the Indian Constitution puts public health under the domain of state government. Thus, all state governments are taking proactive steps to provide basic medical facilities at primary, secondary and tertiary levels. AAMC is one such initiative by the Delhi government, wherein PHCs are being established with the objective of providing free of cost essential health services, consultation and medicines to all.

The AAMC scheme is a part of the AAP government’s strategic shift ‘to move care beyond the hospitals to the community’, so that patients on verifying their Aadhar Card can receive effective medical care closer to home within a radius of five kms acting as neighbourhood health-centres, mostly around lower-middle class areas and urban slums.

Journey

The first AAMC was opened in a relief camp located at Peeragarhi in July 2015. Thereafter, the pace of establishing MCs has been hindered due to the procedural hurdles in obtaining clearances from the civil agencies like the Delhi Development Authority and Municipal Corporations. With the current political winds, view differences in the state and central administration, the programme was further pushed to the back burner.

This slowdown in the implementation of AAMC is also reflected in the budgetary allocation under which, out of ₹60,000 crores annual budget of Delhi government for the year 2019-20, 14% had been set aside for providing health services, i.e., 7485 crores. Out of this amount, only 6.9%, i.e., 375 crores is being devoted towards Mohalla clinics, which is lesser compared to the amount of ₹403 crores allocated in 2018-19.

The AAMC scheme is a part of the AAP government’s strategic shift ‘to move care beyond the hospitals to the community.’ Image source: indiatvnews

With the importance accorded to AAMC by the AAP government and much-needed improvement in PHC services, a survey was conducted in different parts of Delhi (South and West Delhi) by visiting and witnessing the ‘on-ground’ performance of AAMCs.

While the patients gave feedback readily, the staff and doctors were not very forthcoming, primarily due to the workload and partially due to apprehension of being interviewed by an outsider and possible implications, as they are all contractual employees. The clinics were chosen to have representation from a wider spectrum of the demography of Delhi.

The Survey Revealed The Following Attributes Of Functioning Of AAMCs:

Infrastructure And Hygiene

A majority of the Mohalla Clinics have been opened up in rented premises as clearances for establishing clinics on government land were not coming through easily, view procedural hurdles. The Testing Laboratories for the clinics are outsourced to minimise fixed liability. Even though most of the clinics have bilingual signboards outside, locating them becomes inconvenient for the migrating population as they are situated in the midst of village areas.

Staffing

Each Mohalla Clinic is staffed with a team of three personnel: a doctor, a nurse and an office assistant, who are employed on a contractual basis. Delhi government intends to revise per patient rate for doctors to ₹40/- with assured 75 patients per day, which is a welcome step. The workload at most of the Mohalla Clinics is heavy, given the limited working hours of 8:00 am–2:00 pm on all weekdays. The Chief District Medical Officer undertakes monthly inspections, wherein all the facets of functioning are examined and performance and requirements of the clinics recorded.

Treatment And Footfall Of Patients

Crowded areas such as Chhatarpur receive about 80–100 patients on a regular day and more than 150 patients on busy days (Mondays). The lower and lower-middle class prefer AAMCs to private hospitals since they are provided with all medicines, consultancy and treatments free of cost. For secondary and tertiary treatments, patients are recommended to visit the bigger hospitals viz.— Safdarjung Hospital, Deen Dayal Hospital, etc., which are equipped with all health services. Samples are sent to laboratories that they have ties with, and the test reports are made available within two days.

On the holistic front, AAMCs has been a huge success. However, a few recommendations which could be considered are:

  • Extending the timings by initiating evening shifts.
  • Providing for emergency services.
  • Keeping politics out of healthcare, the state and central government must support the establishment of more AAMCs at the earliest.
  • The government websites need to update data regarding their locations, timings and facilities being extended.
  • A visiting female doctor to aid women patients to seek medical advice on maternity/gynecological issues.

The success of AAMCs is showing up in other states of the country as well. The Madhya Pradesh government, taking a cue from this programme, has initiated ‘Sanjivini’ Medical centres, which again aim to aid primary health of the public free of cost and is being established in every ward of metropolitan cities of the state.

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