MOHALLA CLINICS - GAME CHANGER IN WORLD PRIMARY HEALTH CARE SYSTEMS.

MOHALLA CLINICS - GAME CHANGER IN WORLD PRIMARY HEALTH CARE SYSTEMS.

MOHALLA IDEA:

When the idea of “MOHALLA CLINICS” was mooted, it was not taken seriously or brushed aside as another routine initiative from Government. Even the media did not give due attention it deserves. Aravind Kejriwal popularly known as AK is so determined with the idea and advised the health minister and his team to study health care systems in different states and countries and apprise him. With an unimaginable speed, the idea became reality and Delhi is blessed with about 110 Mohalla clinics and in the direction to reach targeted 1000 mark once the existing system created  hurdles are cleared.  

THE STRATEGY:

Health care to all at affordable cost is the goal and to reach it, a three level extensive health management system with intensive approach is being planned and implemented. Mohalla clinics ( Community health care) to provide diagnosis and treatment facilities to primary health needs , followed by polyclinics with surgeries and hospitalization and further super specialties to address alignements like Oncology, Urology, Cardiology, Gastroenterology etc are part and parcel of this three tier approach.

In this three tier system Mohalla clinics is new invention to reach out to people at their door step and a totally new setup is being created. Whereas the existing Area hospitals, Primary health care centres with further strengthening and expansion are fitting into NEW POLYCLINIC and Safdarjung , JPN, AIIMS, Lohia, Deendayal etc  will take of specialty and super speciality needs.

MOHALLA CONCEPT:

Mohalla clinics concept is designed in such a way that each center caters the primary health needs of about 10000 to 12000 population and bottom up approach starting with slums & migrant population is being followed. These are having interface with polyclinics each one is  planned to cater to the needs of about 50000 to 70000 population.

The clinics are of two room design with about 500 to 600 sq ft compact area , well designed layout with good interiors and exteriors and very well maintained. Each centre is equipped with medical dashboard (cloud based health record management system), swasthya slate (health tube), a compact medical device (cost effective one designed by Mr. Kanav Kahol, an Indian biomedical engineer at Arizona state university, USA ) which can perform about 30 plus common medical tests like blood, urine, BP, Sugar, dengue, typhoid etc and has interface facility with dashboard and patient can see the results in less than 10 minutes time, Refrigerator, Air Conditioning, medicines vending facility. The centre is operated by 3 to 4 staff which include doctor, midwife, pharmacist and helper .  Automatic medicine vending facility which can accommodate around 60 to 70 types including syrups is being put to test on trial basis with the support of USAID. Once the idea clear all operational issues it is going to revolutionize the pharmacy management. Doctors are hired on contract base and paid based on patients attended basis. The entire patient management chain is paperless and even referrals to the polyclinics is operated through artificial intelligence software linked cloud based technology.

2003 AP VISION - REFLECTIONS:

I am sure it is not out of place to mention that Sri. Chandrababu Naidu (CBN) was having such ideas in mind a decade back , hence referred as visionary CM. I personally had an experience with him and feel it is worth sharing.  I was engaged with AP state in promoting door step Artificial insemination & mobile health care for cattle in AP.

I was given an opportunity to present our work to CM in 5 minutes time. When the presentation started with Kuppam, CM constituency and proceeded further into Chittoor dist, it generated more interest in him and asked me to continue further in detail. When I was making presentation on mobile health care which can be done by trained worker ( not veterinarian) ,Director- AH of state ( a good friend of mine) took objection, for which I did not yield.  CM intervened and asked me to list out all the activities related to cattle management & health care. Once I put down the activities on white board , he asked DAH to tick the activities which can be done by trained worker. DAH ticked about  90 % activities which can be handled by trained worker, not necessarily veterinarian.

CM quickly presented his vision on 3 tier veterinary care  which include village level facilities manned by trained workers, Mandal level institutions covering inbreeding , disease control etc manned by undergraduate/graduate vets , followed by super speciality facilities at district level handling complicated cases, surgeries etc manned by graduates/doctorates. This vision could not come into reality as he lost power in 2004 elections and back again after 10 years as CM to separate AP state.

MOHALLA CLINICS OPERATIONS:

People are finding them very convenient and time saving as they are located in their neighborhood. It was expressed by people that earlier they used to neglect the fever or cough as it was not convenient to visit private doctor or PHC and get into major problems. With mohalla clinics, they are very quickly using the facility and it is helping them in preventing further complications.  The medical history generated through online system is very useful for future treatments and acting as quick referrals.

Medicos living in the local areas, Medicos with social service bent of mind,  Medicos who preferred earlier to stay at home as housewives are finding it very interesting and extending their services more on social lines and generating interest in patients.

Once the patient come most of the cases are treated as OP and medicines are given free of cost and in selected few cases further diagnosis is done before medicines are given. Few are being referred to polyclinics without any delay with linked ambulance service and online transfer of medical history.  With this facility even the complicated or emergency care is provided without much of time delay.

The average OP is around 80 to 100 in normal days extending to 150 and above during climate change periods is one major indicator to prove the popularity of Mohalla clinics. In long run with efficient preventative healthcare facilities at Mohalla clinics , the percentage of cases at next level health care shall come down.

These centres have further scope to extend facilities with Aadhar linked delivery systems, mother and child care, family counselling etc and can effectively function as one shop solution for poor and needy in family & health care. Looking at the face & clarity with which Delhi Government is moving forward the day is not far to achieve the desired goals to the satisfaction of everyone.

WE SHALL OVER COME:

There is criticism that the rental paid for clinics are on higher side and it’s an avenue for Aam Aadmi party cadre to make a living. Field observations revealed that there are cases where people volunteered their premises on nominal rental basis. In fact Government is looking for providing permanent places . In fact Lt. Governor is holding the file to clear 300 mohalla clinics proposed to be operated from Government school premises with separate entry and not disturbing school functioning.  It is painful to state that it is easy to get acres of prime land for party offices, memorials etc in Delhi and when it comes to welfare of people hundreds of rules will be quoted as hurdles.  In 1984 when we wanted to open 100 mother dairy outlets to sell fruits & vegetables ( present SAFAL), a three member team (I was a member) was given a task to identify, prepare drawings and submit the proposal. We could complete the task in 15 days and it took Late  Dr. Kurien another 15 days to get it cleared from DDA & few other bodies.  I am sure GOI will extend similar service to Delhi Government & give them an opportunity to serve people.

Few are raising eyebrows on doctors appointments, payments, operational efficiencies, quality of services, wrong diagnosis etc. The public opinion by and large is in favor of the functioning of clinics and service delivery is being appreciated.

Care shall be taken while replicating the concept and scaling up the operations.

FUTURE VISION:

Scaling up & sustaining the program without looking it as revenue model is a real challenging task and future governments may feel it as burden and dilute it ( your baby it not our baby and certainly not my baby theory ).  It needs to be seen from long term sustainability and plan for Corporate social responsibility linkages, nominal user fee to begin with, international funding, promoting local volunteerism etc and ensure that the burden on budget is eased to maximum extent.  This strategy will certainly bring in sustained quality of service and accountability.

This innovative Mohalla clinics concept may be a good alternative and worth replicating in all states at least to begin with in all urban pockets. GOI promoting health ATMs on experimental basis in few states may have get synergy from Mohalla clinics and scale it up.

As reported in Wasington Post in March,2016 , Mohalla clinics drew attention of US Government and looking at its success with more seriousness. Despite best opportunities still over 10% ( over 33 million ) of US population are not covered under health insurance as they are the real poor and mostly black population. Knowing the exorbitant cost of health care in US, it is impossible for them to get preventive care , often end up with serious illnesses which are much more expensive to treat and often families end up with bankruptcy.  

ARAVIND KEJRIWAL’S INNOVATION - MOHALLA CLINICS MAY NOT ONLY GIVEN HEALTHCARE SOLUTIONS TO LATIN AMERICA , HAVE GREAT POTENTIAL TO GIVE ALTERNATIVES TO FIX US BROKEN HEALTH CARE SYSTEMS.

ONE HAS TO SEE HOW FAR THE HEALTH INSURANCE, PHARMA COMPANIES, MEDICO NETWORK WILL ALLOW THIS CONCEPT TO SUSTAIN AND MOVE FORWARD ACROSS THE GLOBE.

IT IS REAL CHALLENGE TO THE COMMON MAN - AAM AADMI. GOVERNMENTS WILL COME AND GO, IT IS FOR THE PEOPLE , BY THE PEOPLE TO SAFEGUARD THE PUBLIC INTEREST.

B GURUVA REDDY

grbonthu@gmail.com, 9866889246