Though it needs refinement, the programme’s outreach shows promise, and can be adapted across the country
Two relatively new, publicly funded models of healthcare delivery available in India today owe their origin to competing ideological beliefs supported by opposing political formations. This is useful, as it offers a policy choice based on one’s beliefs.
One is the BJP government’s Ayushman Bharat scheme, which has two components. One is to have in place 1.5 lakh health and wellness centres — essentially by upgrading government-run primary health centres — in four years, delivering primary care. The other is to offer an annual health insurance cover of ₹5 lakh per family to the bottom 40 per cent of the population for tertiary care. This is managed through trusts and health insurance firms, and delivered mostly by private hospitals.
The latter is more glamorous, in the public eye and pushed by policymakers.Progress on the health and wellness centres, on the other hand, has been slow and receives minimal official attention and publicity.
The other publicly funded model for primary care is the mohalla clinics innovated by the Aam Admi Party government of Delhi. This has caught the public eye and become a source of political disputation, with BJP sections seeking to shut it down.
If a publicly funded healthcare delivery model is to succeed, it must have strong political baking. The health and wellness centres do not, while the mohalla clinics do. Set up in 2015, it is a star programme of the AAP, which will seek to be judged in part by the clinics’ performance when Delhi heads for the polls next year.
Importantly, the mohalla clinics have shown some signs of success. The Congress-led government of Madhya Pradesh has decided to adopt the model and set up its own chain of primary healthcare centres, ‘Sanjeevani Clinics’, for the poor in four of the State’s largest cities. Additionally, the mohalla clinics seem to have been noticed internationally.
The HT Chan School of Public Health of Harvard University, according to news reports, is likely to study the model and prepare a case study on how primary healthcare can be delivered in urban neighbourhoods through the public system.
The programme is somewhat akin to the West Bengal government’s Kanyashree scheme, which offers financial assistance to growing girls so that they continue with education and not get married too early. This scheme has won a UN award.
It is useful to take a look at the salient features of the mohalla clinic to see if this is a workable, low-cost model for State delivery of primary care to the urban poor that can be replicated across the country.
The Union Territory of Delhi, not very large, runs 300 mohalla clinics in poor urban neighbourhoods. The aim is to ensure that the poor do not have to travel long distances to get free, quality diagnosis and treatment for minor ailments.
It is only when something serious is indicated that the patient has to journey to a government hospital. Proximity is important for primary care, as having to travel and stand in long queues can mean the patient having to forego one day’s wages.
According to a survey by IDInsight, many users of services available at mohalla clinics found them to be as good or better than at other facilities. Ninety-seven per cent of those who visited the clinics said they would come again. However, there is scope for improving the quality of care and infrastructure. Forty per cent of users felt that regular availability of staff, medicines and diagnostic tests could be improved; as well as infrastructure facilities like drinking water and size of the waiting area.
People must be made more aware about the clinics and better signage should be used to make them easier to locate.
According to another study by research scholars at IIT-Delhi, the clinics are used mainly by people with modest income, and by housewives. Forty-three per cent of patients came with minor ailments, 26 per cent with pains and 21 per cent with chronic ailments. For around 80 per cent of those who visited the clinics, medical and commuting expenditure was brought down. Commuting time was also reduced for 77 per cent; 89 per came on foot, taking on average 10 minutes to reach the clinic.
Budgetary allocation for the clinics has gone down by 7 per cent in 2018-19 compared to the previous year, and there are very few facilities available for pregnant and lactating women. Consequently, they make up most of the 8 per cent who did not find the clinics useful. However, 68 per cent felt the treatment they received was effective.
The mohalla clinics have a long way to go. The programme is particularly hamstrung by the poor availability of accommodation and, of course, funds. But the clinics are significant and appear to have emerged as a workable model for delivering state-funded primary healthcare of acceptable quality free to the urban poor at an affordable cost to the system.-The Hindu Business Line