MOHALLA CLINICS – TAKING HEALTHCARE TO THE DOORSTEPS OF POOR

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In today’s times, we can find a huge private or government hospital or a nursing home nearby our homes, in case we suffer from any form of disease like cardiac arrest, asthma, cancer and cough and cold to name a few. But, there arises a situation, where some of the healthcare institutes do not have the provisions to treat a certain kind of disease. For instance, operation procedures of heart and joints cannot be done in nursing homes, as they treat only general diseases like cold and flu, birth delivery and so on.

But sometimes, for availing the services of such life threatening diseases at huge hospitals, it can become a painful affair, as other people have come for the treatment of the same disease, say heart attack possibly or some other illness. This often leads to congestion in healthcare centres and untimely availing of the much needed resources, required for reviving and helping the patient limp back to normalcy slowly and steadily. And by paying higher expenses in private hospitals, the situation becomes worse among the middle and the lower class people. So how do we tackle the increasing menace?

Enter ‘mohalla’ clinics, literally meaning, ‘neighbourhood clinics’ in Hindi, which aims to solve the existing above problem amicably. It was first propagated by the current Aam Aadmi Party (AAP) government in its election manifesto, during the campaigning of the Delhi Elections last year. It could be termed as a populist measure, but have the potential to meet the needs of the people, make basic healthcare accessible and decongest higher level health facilities. These could also prove to be a landmark in health service delivery in India.

Decentralisation of healthcare was one of the first promises made by the AAP government that was greeted with much fanfare. In July last year, within five months of coming to power, the first mohalla or neighbourhood clinic was inaugurated in Peeragarhi in North-West Delhi. The clinic, an air-conditioned porta cabin structure, has two doctors to see patients, order basic investigation and provide limited medicines.

In order to decrease the crowd at government hospitals, this was to be the first of 1000 such clinics that would form the first rung of the restructured government healthcare system. As the government celebrated one year of being in power in February, the Peeragarhi Mohalla Clinic remained the only such clinic yet till March 31. The second rung, polyclinics with specialists from four to five disciplines, were planned from revamped dispensaries.

These clinics would be associated with Delhi government hospitals and doctors from these hospitals were to conduct OPDs by turns. But again after two clinics started last year, another 21 of them were being inaugurated yesterday, taking the number to 22 so far.  The first one was be inaugurated by the Chief Minister Arvind Kejriwal in Seelampur in North-East Delhi yesterday.

According to the plan, the government decided to reduce a significant part of the crowd in hospitals by building and strengthening the first two rungs of the health system. As Kejriwal said during the inauguration of the Mohalla Clinic, people would only visit hospitals when they were extremely sick. There would be 150 polyclinics to support the mohalla clinics.

Asked about the delay in executing this new system, Delhi Health and Power Minister Satyendra Kumar Jain said that the government was committed to making it a reality. “Any new system needs some time to take shape. We had to let the first mohalla clinic function for a few months before we started the new ones,” said Jain.

He said after a trial run of the polyclinic at Kanti Nagar in East Delhi, the government would start 20 more of them. “The feedback for polyclinics has been excellent. Majority of people using it are first-timers.,” added the minister. Jain added that around 1000 mohalla clinics and the 150 polyclinics would be in place by the end of 2016. The timings of both the Mohalla Clinics and the polyclinics are from 7am to 7pm respectively and is open on all days, irrespective of any festival or national holiday coinciding.

While inaugurating the second clinic at Munirka in South Delhi, Kejriwal said – “While the previous dispensation spent Rs. 5 crores for setting up dispensaries, we are setting up mohalla clinics at a cost of Rs. 20 lakhs. Here in these clinics, we are providing free treatment, medicines and diagnostic facilities. You can avail these facilities for minor ailments. You do not need to go to a private doctor anymore.”

Dr. Tarun Seem, Secretary, Health and Family Welfare, Delhi Government, says his department is working on identifying and resolving issues like how to replenish the pharmacy or monitor the work output of the doctors.“In the next six months, we would have figured out a lot about the kind of problems faced while running these many retail OPDs. Monitoring, management and mentoring or even supervision becomes that much more complicated. We are proposing to use IT for that. The software and the tab are being finalised. The patients are going to be identified on the basis of a unique identifier, like the Aadhar number or telephone number or election card or something,” he says.

There are other issues that need attention – The new clinics would run for only one shift because there is a shortage of doctors. The Peeragarhi clinic has staff on deputation from the National Health Mission. The staff members are on contracts that pay them less than Delhi government employees. There is obviously dissatisfaction over it. For the mohalla clinics to succeed, the Delhi Government will have to ensure doctors show up. Delhi already has an existing chain of 260 dispensaries, under the Delhi Government which over the years, have become unpopular among patients because of absenteeism among doctors and shortage of medicines.

The polyclinics provides several specialities apart from general medicine, including surgery, gynaecology, paediatrics, dermatology, orthopaedics, ophthalmology and ENT (ear, nose and throat). Other services include homeopathy, Directly Observed Treatment, Short Course (DOTS) for tuberculosis, cancer screening and counselling for HIV patients. The most common cases recorded at the polyclinics are of hypertension, diabetes, diarrhoea, pneumonia in children and skin allergies.

Health services have also been organised into a four-tier system by the government – mohalla clinics that will provide basic healthcare forming the first layer, followed by polyclinics or multi-specialty clinics, secondary hospitals which will be re-named as multi-specialty hospitals and, finally, advanced or super-specialty hospitals. there will be five health directors – one each for north, south, east, west and central districts. The regional health directors will report to the director of health services, a post that will be upgraded to director general (health services). The director of family welfare will continue to function, looking into maternal and child health programmes as well as family planning programmes under the National Rural Health Mission (NRHM).

Once they take charge, the regional health directors have been asked to prepare reports on the demographic profile of their areas, existing health infrastructure and how to upgrade healthcare services. The directors will oversee the functioning of all the four tiers, ranging from the mohalla clinics to the super-specialty hospitals. They will also oversee the expansion of clinics and construction of new hospitals.

“The restructuring of health services will prevent overcrowding at hospitals. We are trying to create a system where only patients who need advanced care go to super-specialty or secondary hospitals. The official added that the government will ensure that patients requiring basic diagnostic and treatment facilities do not travel long distances or get long dates for consulting doctors”, said an AAP official.

Jain said that the AAP government had first studied the health systems of other countries. “We came up with this concept only after studying the health systems of the US, Brazil, Switzerland and Cuba. The facility was cost-effective and easy-to-maintain due to its optimum size. The cost of building one Mohalla Clinic is between Rs. 15 lakhs and Rs. 20 lakhs, while a PHC requires Rs. 3 crores to Rs. 4 crores,” Jain said.

“We want the middle-class people to visit the Mohalla Clinics. We will also increase facilities at these centres. For instance, mobile applications will enable people take appointment without standing in a queue. The ultimate aim is to improve the health infrastructure. Common people visit government hospitals for minor ailments that reduce their efficiency. Once they start coming to Mohalla Clinics, the burden on hospitals will reduce,” he added.

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