sulabh swatchh bharat

Tuesday, 25-June-2019


Lancet journal has praised the Delhi’s cloud-based, pilferage-free medical care system at the grassroots

Dinesh Kewat, a vegetable seller, has fainted thrice in past one week. He didn’t want to visit the government dispensary due to the abnormally long delays. His daughter, Neha, was told by her teacher about Mohalla clinic in her area. At the Azadpur clinic, the doctor examined Dinesh and asked for his blood test. Within minutes, his test report was out. For an adult male of his age, Dinesh’s hemoglobin levels were abnormally low at 11.2 g/dl. He was prescribed the medicines which he got from the pharmacist right over there. Within 20 minutes, Dinesh and Neha walked out of the clinic with a relief on their face.

Close to 1.5 million patients like Dinesh have been catered to by 106 such mohalla clinics of Delhi in last one year.As the name suggests, each clinic covers a mohalla, roughly a population of 10,000 residents. The structures set and the processes followed in mohalla clinic are intended to provide relief to the common man without any hassles and unnecessary delays.

 Problems galore

Indian healthcare system is in dire need of revamp. We are a nation of 1.3 billion people and with just 9.29 lakh doctors registered with Medical Council of India (MCI), we have an alarmingly high doctor-patient ratio of 1:1674. These figures in states like Bihar will startle you to the core, with one doctor serving 28,391 patients! Globally, only 17.87% of the total health expenditure is taken care of by the individuals themselves. But in India, this figure stands at 57.57%.

These statistics are a mere representation of the sorry state of
affairs.The ground realities are much more poignant. India can’t become
a superpower with an unhealthy, unproductive population. Indian hospitals have faced undue pressure due to dilapidated primary health care system Most of the cases which land up in government hospitals could have been treated at primary or community level, if we had robust systems in place. As per Union Health Ministry’s data, India has a shortfall of 22% in Primary Health Centres (PHCs) and a massive shortfall of 32% in Community Health Centres (CHCs). 

 Unique Model

Mohalla clinics brought a renewed focus on primary health care. Mohalla clinics offer a unique model where consultation, medicines and diagnostics services are provided under one roof and are free for people from all walks of life. Delhi government claims that the setup cost of mohalla clinic is mere Rs. 20 lakhs, as compared to Rs. 5 crores for a dispensary. Most of the mohalla clinics have been setup in rented spaces, thus saving huge costs. The doctors, who are recruited on contract basis, are paid Rs 30 per patient as consultation charges.

The processes at Mohalla clinics have been setup keeping in mind the patients’ convenience. A token system is followed for the people visiting the clinic. Everyday 80-100 patients are served in a clinic and average wait time is 20-30 minutes, depending on the crowd. Once the details of patient are fed digitally, the doctor examines the patient thoroughly and prescription is generated. The prescribed medicines are made available, free of cost, right over there. The case details of the patients along with biometric listing are uploaded on the cloud, which can be accessed instantly. Case history is very important in medical field and its digital access saves a lot of time.

Swasthya Slate, a medical device developed by Dr Kanav Kahol, is making the diagnostic tests a cakewalk. It is integrated with the cloud based system to upload the test data instantly. Some of the clinics are also equipped with medicine dispensers, which reduce the pilferage in the system. The sensors in the ‘medicine ATMs’ screen the prescription and dispense the medicines, ensuring transparency and efficiency. The use of technology to cut the costs and streamline the processes is proving to be a boon for the mohalla clinics.

 Power of the idea

Recently, Lancet journal had all praises for the mohalla clinics. “Evidence from around the world shows that increasing access to publicly financed primary care is the best way to accelerate health coverage. Mohalla clinics appear to be putting this strategy into operation. There is already a good case for scaling this up in Delhi and potentially in other Indian states because people seem to like these services,” said Robert Yates, Senior Fellow at Chatham House, London, UK, after a recent visit to a clinic in Delhi.

As per the NSSO report, 44 out of every 1,000 individuals get hospitalized every year. A decade back, the figure was 31, showing a sharp increase of more than 40% in hospitalization cases. The number is bound to increase in future and unless Indian health infrastructure is equipped to handle this, it would face a significant loss to GDP due to rising healthcare costs. Mohalla clinic offers a low-cost, replicable and sustainable model, which is bringing the healthcare right at the doorsteps. UN Sustainable Development Goal (SDG 3) targets, “Ensure healthy lives and promote well-being for all at all ages”. Mohalla clinics are going to be very effective in meeting this goal.