"It may well be time for America to build mohalla clinics in its cities" -- March 2016, The Washington Post [1]
“A Network of local mohalla clinics that are successfully serving populations otherwise deprived of health services.” -- 'The Lancet' in December 2016 published a research article[2]
*The Lancet is world's highest-impact academic journal and one of the oldest too
Detailed Article on evolution of 'Mohalla Clinics or Aam Aadmi Clinis': AAP Wiki: Aam Aadmi Clinics Evolution
Former Secretary-General of the United Nations Ban Ki-Moon visted the clinics and praised the initiative[3]
“Chief minister Arvind Kejriwal has great vision to make sure that primary healthcare is available to the poor and the vulnerable people. Mohalla clinics and polyclinics are the examples of what government’s and politicians should do for the people. I deeply appreciate the chief minister and the health minister… I have travelled to many, many places. What I have seen today, the clinics are much systemic, well-organised and well kept. I am very impressed…”
Former UN Secretary General Kofi Annan lauded the Delhi government[4] for providing free primary health care through Mohalla Clinics -- an initiative that's "consistent with the Universal Health Coverage (UHC) goal" of the WHO
Nobel Laureate Dr. Amartya Sen too had hailed the idea[5] of clinics and remained inquisitive about the model, and its disruptive implementation using technology. He appreciated Delhi Govt's proclivity in bringing a reform in health services
Dr Gro Harlem Brundtland, Former Director General of World Health Organisation and Norwegian Former Prime Minister[6]
"The footfall of Mohalla Clinics indicate the huge unmet need for free universal health care. The health care reforms being undertaken in Delhi strike me as an excellent strategy,”
Chris Gayle, International Cricketer Player[7]
“What Mr Bhagwant Mann (Chief Minister of Punjab) has done; he has done something fantastic by opening about 500 clinics (Aam Aadmi Clinics of Punjab). So, that is something fantastic as well. We need more people like him with a good heart to spread these things around the world.”
The Stanford Social Innovation Review, Health Care in the Mohallas[8]
"According to most estimates, health insurance policies cover less than 10 percent of India’s 1.2 billion population, and the national government has mostly failed to fill in the gaps. Public spending on health care is only about 1 percent of India’s GDP, one of the lowest rates in the world. An ambitious plan by Delhi’s local government aims to give the city’s poor better access to health care through neighborhood clinics."
The Oxford University's Health Policy and Planning, A comparison of the cost of outpatient care delivered by Aam Aadmi Mohalla Clinics compared to other public and private facilities in Delhi, India.[9]
"The cost per visit at a Private clinic in Delhi at ₹1146 was more than 3-times higher than that at of any other Govt run Urban Primary Health Centre ₹325 and 8-times higher than that at Aam Aadmi Mohalla Clinics - ₹143. The annual economic cost per facility of a Govt run Urban Primary Health Centre at ₹ 92,80,000/$130 000 is ∼4-times that at Aam Aadmi Mohalla Clinic (₹24,74,000/$35 000). Unit costs are found to be lower at Aam Aadmi Mohalla Clinics."
"Such higher investment in public primary care facilities with expanded services for prevention and promotion, upscaled infrastructure and a gate-keeping mechanism can strengthen the delivery of primary care and promote universal health care at a lower cost."
Discover Social Science and Health, Making primary healthcare delivery robust for low resource settings: Learning from Mohalla Clinics. Authors : Md Haseen Akhtar, Janakarajan Ramkumar - Both from IIT, Kanpur.[10]
"In Delhi, the Mohalla Clinics’ well-considered design distinguishes them from conventional healthcare facilities"
"The approach of Mohalla Clinic applies to the entire country, not just Delhi, because these are problems that most Indian states face regarding their health systems. Patients can receive medical attention at these clinics because they are permanent healthcare institutions. People in the community will need to be counselled and transported to receive medical treatment soon. If they receive preventive and promotion health services for emerging and re-emerging noncommunicable diseases and risk factors (e.g., diabetes, high blood pressure, various cancers, and ophthalmic issues)."
"The dengue and chikungunya outbreaks that occurred in Delhi in September and October of 2016, where health facilities were overrun with patients, Mohalla Clinics became an important entrance point for patients seeking medical attention and undergoing dengue lab testing. All patients with symptoms were tested in Mohalla clinics, results showed the early detection and treatment in most of the cases."
International Journal of Community Medicine and Public Health, A study on the availability and accessibility of healthcare services provided at Mohalla clinics by the slum residents of Delhi.[11]
"Awareness about Mohalla clinics: During the study, it was observed that all the slum dwellers were aware about the existence of Mohalla clinics. Utilization pattern: majority of the households (63.1%) visited Mohalla clinics for seeking healthcare services within last seven days of taking the interview. 35.1% respondents had visited Mohalla clinic within 7-14 days of giving the interview and the remaining. The average waiting time to avail services was 0-30 min (75.1%), 31-60 min (9.8%)."
"Maternal healthcare: Mohalla clinics also provides preventive services in the form of ANC and PNC care for females. Majority of the patients did not bear any cost on consultation (97.9%), investigation (98.9%), drugs (98.9%) & transportation (99.5%)."
“The Mohalla clinics have opened new doors for the community members to seek treatment for the basic services for which initially they had to travel to the far off healthcare facilities and the services provided here are at par with the services provided at the dispensary before”. (A 34 years old female ANM worker, Mohalla clinic)
JOURNAL OF KARNALI ACADEMY OF HEALTH SCIENCES, Can the Delhi Government’s ‘Mohalla’ clinic overcome its challenges and provide quality health services to the urban poor population? *Authors : Bhuvan K.C, Malaysia, Pathiyil Ravi Shankar, Saint Lucia, Sunil Shrestha, Nepal.[12]
"The population density of Delhi favoured the cost effectiveness of the clinics and the one-time establishment cost of two million Indian Rupees (around 31000 US dollars) per clinic was much less than the cost of building a tertiary hospital. Assessment of Mohalla Clinics shows that the program has improved overall access to basic healthcare and is liked by people, and the program has potential for growth."
Concluding "In the era of increasing urbanisation, the urban poor living in the crowded cities of South Asia such as New Delhi, Mumbai, Calcutta, Kathmandu, Dhaka etc.need such an urban health program which can provide them with good quality basic healthcare services and medicines."
Journal of Family Medicine and Primary Care, Mohalla Clinics of Delhi, India: Could these become platform to strengthen primary healthcare? *Author - Chandrakant Lahariya, National Professional Officer, Department of Health Systems, World Health Organization (WHO)[13]
"Mohalla Clinics as a concept has a number of widely acknowledged strength to become successful health intervention and a few limitations as well. Therefore, it is not a surprise that a number of Indian states (as of 2017, when the article was published) i.e., Maharashtra, Gujarat, Karnataka, Madhya Pradesh, and a few municipal corporations (i.e., Pune) have shown interest to start a variant of these clinics. There are at least two “proofs of concept” of success of these clinics. On demand side: people have “voted by their feet” and there is high demand for services at these clinics. Second proof is political interest, (which is very important from political economy perspective) and inclination of a number of Indian states to start health facilities on similar design. The politicians and political leaders have a knack to feel pulse of people and this is one such initiative which is widely popular amongst masses. These clinics, analyzed from health systems perspective, performs well on accessibility, equity, quality, responsiveness, and financial protection, among other."
"An automated medicine vending machine (MVM) at Todapur Mohalla Clinic in Rajendra Place, Delhi was set up on August 22, 2016. The MVM can stock up to fifty different types of medicines, both tablets and syrups and uses sensor technology to dispense medicines based on a doctor’s prescription. With MVM, a patient can collect the prescribed medicines directly, which prevent human interventions and reduces risk of medicines not being dispensed while still in stock. The machine dispenses medicines only when a doctor prescribes on a connected tablet and cut the need for a full time pharmacist"
"Mohalla clinics success has proved health services acquire the ability to influence electoral outcomes and catalyze efforts to strengthen health systems, amongst other. These steps would be essential as India aims to advance towards universal health coverage. Mohalla Clinics may prove one such small but important trigger in this remarkable journey."
Journal of Family Medicine and Primary Care. Access, utilization, perceived quality, and satisfaction with health services at Mohalla (Community) Clinics of Delhi, India. *Author - Chandrakant Lahariya, National Professional Officer, Department of Health Systems, World Health Organization (WHO)[14]
"The time taken to be attended by doctor had also reduced drastically from upto a few hours to less than 30 min. The cost of transportation had reduced in majority of cases as these clinics were in walking distance. There was high level of satisfaction among beneficiaries was recorded in ALL the studies, which went up as high as 97%."
"Mohalla clinics seems to have potential to shift the focus from specialist care to a general physician-based health services. These clinics are bringing the attention back on the role primary healthcare physician can play in a system which has excessive attention on super-specialist care. Healthcare system in Japan is an example where in spite of most modern and advanced technologies, health services focus, and importance of primary care physicians is fully understood. The practitioners of primary healthcare are rarely recognized."
"Time spent by doctors with patient at Mohalla Clinics was higher than other facilities and was associated with higher satisfaction. This is fully in consonance with global evidence where smaller clinics have been found to be associated with higher patient satisfaction, better treatment compliance, regular follow–ups, and improved clinical outcomes. The longer and personalized patient–doctor interaction time at Mohalla Clinics could clearly have been associated with regular use of these clinics as well as return visits."
"There are reports where doctors at Mohalla clinics of Delhi have been involved in mediating social issues of domestic violence and problem of alcoholism. This has created a connection between doctors and other healthcare providers and communities being served. This provides a very conducive opportunity and environment, which should be effectively used for increased people's participation in health, deliver preventive and promotive health services (people are more likely to be receptive) and address social determinants of health (i.e,. improved sanitation, improved water supply, etc.). This personal touch between doctors and patients and communities can results in better health outcomes and reflects the potential of these clinics."
"Many have argued that these clinics have placed health higher on the political agenda, as was noted in recent national and state level elections in India, a potential which can be further harnessed with engagement of community and civil society organizations. The concept of Mohalla Clinics is being widely accepted by many other Indian states."
The Journal of Business Perspective, Mohalla Clinic: A Case on Healthcare Service Operations and Quality, Vision.[15]
"The healthcare operations of Mohalla clinics had been backed by many innovations such as fee-for-service payment model for healthcare staff, portability of clinic’s infrastructure and adoption of innovative medical technologies for minimizing the patient turnaround time. These clinics had successfully reduced the out-of-pocket medical expenditures for the targeted households besides reducing the workload of secondary and tertiary service centers in the national Delhi. Mohalla clinic had earned recognition from global public healthcare experts as a scalable and sustainable healthcare model by achieving its goal of providing universal health coverage (UHC)."
Journal of Scientific Research, Institute of Science, Banaras Hindu University.[16]
"Majority of the sample were adult women between 30-59 years of the age. Around 60.7% were women and 39.3% were men More than onethird of the sample was comprised of senior citizens. All the doctors were well educated and experienced doctors as well as staff. Majority of the doctors has more than 10 years of experience in their respective medical field.The majority of respondents said that it takes only 5-15 minutes to reach Mohalla Clinics from their place. There were around 3-4% who said that it takes around 20-30 minutes. Doctors of Mohalla Clinic can refer their patients to higher institution depending on the need of the patient."
"Majority of people stated that the medicines provided in Mohalla Clinics were mostly effective and curative. Hence, this initiative by Government of Delhi provided a positive picture in terms of providing free medicines, free consultation and free diagnostic tests. It shows that patients who were interviewed were happy because they were getting health services free of cost along with some suggestions for improvement."
"Thus, it has been established that the Mohalla Clinic (Community Clinic) model of door step delivery health care is not only successful but also much needed. Hence, the Mohalla Clinic (Community Clinic) model should be adapted and replicated by governments in the other states of India, and perhaps anywhere in the world."
Frontiers in Public Health, Patient satisfaction with access, affordability and quality of diabetes care at Mohalla Clinics in Delhi, India. Authors : Meenu Grover Sharma, Harvinder Popli - Both from School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, Anu Grover - Strategic Scientific Content, Mangrove Creations LLP, Kusum Shekhawat- Centre for Community Medicine, AIIMS New Delhi[17]
Meenu Grover Sharma led team conducted a survey of 400 Type 2 DM patients and made this observation - "Mohalla clinics are making diabetes treatment accessible and affordable for the marginalized population of Delhi. Positive perception of physician interaction and convenient location of the clinics are the two major contributors to the high satisfaction patients expressed with diabetes care at these Govt run clinics."
Other findings include - "Nearly 12,000 hospital beds, over 200 dispensaries, and several polyclinics are all owned by the Delhi government, one-fifth of the city’s health facilities. Approximately 33.5 million outpatients and 0.6 million (600,000) inpatient patients are examined and treated by Delhi Government-run health institutions in each year. Per capita government health expenditure in Delhi Govt was 1753 Rs, while the average for major Indian states was 737 Rs. More than 110 vital drugs and over 212 diagnostic tests were made available at Zero cost to those who could not afford them."
Commonwealth Journal of Local Governance, Decentralisation and urban primary health services: A Case Study of Delhi’s Mohalla Clinics. [18]
"We find that people are saving two hours and 19 minutes on average; most users responded that they were saving time. Respondents who previously used private healthcare (34%) save about 11% of their average income,i.e. Rs 1,250 month on an average. These lower costs have encouraged the 10% of respondents who previously practised self-medication toget proper healthcare in the Mohalla Clinics."
"On a positive note, Mohalla Clinics have improved access to healthcare for ordinary people during the COVID-19 pandemic of 2020, as the major hospitals of the city have been treating patients with COVID-19 and the private clinics have been shut. The doctors of the Mohalla Clinics in and around Azadpur Mandi were given an additional responsibility during the pandemic: to test people working in the wholesale market for Covid-19 (Asian News International 2020). This indicates that the staff of Mohalla Clinics can be a valuable asset to the city in times of epidemic or any other medical emergency.Since the end of lockdown, Mohalla Clinics are also being used as COVID-19 test centres."
"People in their interviews and during the survey indicated a preference for Mohalla Clinics over clinics run by other agencies like MCDs (When study was done in 2020, BJP was elected in all 3 MCD bodies) and a lot of them have stopped using the services of MCD dispensaries."
Submission for Delhi Citizens Handbook, A Review of 'Mohalla Clinics' Policy of New Delhi, India. [19]
"As of now, the overall feedback received from the patients about the facilities at the MohallaClinics has been largely positive. The satisfaction levels with the facilities, medicines, and testingfacilities are high. Patients were quick to point to the aspects that worked best for them:convenience, reduced waiting time, and better treatment."
"Mohalla Clinics are giving quacks a run for their money. For example, Peeragarhi has plenty of quacks and practitioners of a controversial system of medicine called 'Electropathy'. In Peeragarhi's Punjabi Clinic, these so-called doctors admitted that the Mohalla Clinic was taking away their patients."
"Mohalla Clinics have strong political support. The State Government has already allocated substantial funds for Mohalla Clinics while increasing the health budget by 50%. This is in keeping with the electoral promises made by the ruling dispensation. However, this could also be a challenge since the identification is too strong. For example, there are several visual photographs of the Chief Minister, Mr. Arvind Kejriwal, in the Peeragarhi Mohalla Clinic. The Clinic has earned the popular sobriquet of 'AAP Clinic', rather than the official 'Mohalla Clinic. In Munirka too, the Mohalla Clinic was closely linked to the party MLA."
A Case Study of the Aam Aadmi Mohalla Clinics by Priyanka Yadav, research scholar at the Centre for Political Studies, JNU[20]
"Reality contradictsthe fundamental promise of the Indian constitution, which guarantees health as a primary right under article 21 (right to life). The discourse has shifted from rights to commodities, as privatisation has led to negligence by governments in providing all primary and affordable health care. Indeed, this contradiction in theory and practice is nothing but the denial of fundamental rights and in opposition to the Alma Ata promise, ‘Health for All’. The Bhore Committee Report of 1946, the Alma Ata Declaration 1978, and The National Health Policies of India have all emphasised the need for universal health and ‘Health for All’’. However, the importance of this goal has not been realised yet."
"Aam Aadmi Mohalla Clinics (AAMCs) have strengthened the larger goal of ‘health for all’ in this Indian city. Moreover, it has extended Article 21 of the constitution, which is the Right to Life, to every citizen in an institutional manner. The commodification of health care post-neo-liberalisation has denied many underprivileged their fundamental right to health which is constitutionally their due. AAMCs have been able to make critical interventions in this area. By providing quality care at affordable costs or no cost at all, AAMCs have improved the quality of life for the vulnerable section of society, thereby ensuring respectable life and health for all."
Indian Journal of Community and Family Medicine, What brings people to government urban primary care facilities? A community-based study from Delhi, India. [21]
Nine of every 10 respondents found doctors to be cooperative and gave an average rating of 4.1 out of five. Forty-nine percent of the respondents had at least one test conducted from these clinics, and more women were advised to undergo a test than men (55% for women vs. 41% in men). Three-fourth of all respondents reported that they had access to clinics within 10 min of walking distance.
The fact that majority of the people who started visiting a Mohalla Clinic were earlier attending private (formal or informal) healthcare providers indicates that if health services are provided by the government with assured provision and good-quality services, people would start the using these services.
One of the impacts of Aam Aadmi Mohalla clinics has been that a number of Indian states have started a variant of community clinics or started on other initiatives to strengthen PHC. As an example, soon after the release of India’s National Health Policy 2017, to strengthen PHC system, an initiative by the name of Health and Wellness Centre (HWC) was launched in April 2018.
Indian Journal of Economics & Business, NEW DIMENSIONS IN PRIMARY HEALTH CARE SERVICES: A STUDY OF NEIGHBORHOOD HEALTH CLINICS (MOHALLA CLINICS) OF DELHI [22]
The Supply Chain Management of Mohalla Clinics : "The supply of medicine and other health related equipment is sent on monthly bases or as per need basis by linked Mohalla clinics. The store in charge (Pharmacist) brings medicines and other health related equipment from the district store. Store in-charge brings indent for Mohalla Clinics. Store in-charges had been maintaining all the records of drugs for smooth supply in Mohalla clinics. The district store brings indent from central store, Directorate General of Health Services."
"The Delhi Government had issued strict orders to doctor of DGD only prescribe available drugs in their pharmacy; this had made all complete free medicine to patients. Previously doctors prescribed drugs as per need of patients not according to availability of stock. This practice is restricted welfare of patients."
International Institute of Health Management Research, Functioning and Satisfaction level of Mohalla Clinics. Author : Lt Col Puneet Sharma[23]
The new model will be four tiers, it would include.
● Neighborhood Health Clinics (Mohalla Clinics) of Delhi
● PolyClinic-multi specialty Clinics
● Multi-specialty hospital (earlier called secondary level Hospitals)
● Super specialty hospitals (earlier called tertiary level hospitals)
"Each Mohalla Clinic is linked to a Government Dispensary for logistics support and referral of patient services for example the Clinic at Pochanpur is linked with DGHC Bamnauli, the Clinic at Najafgarh (Ajay Park) is linked with DGHC Nangli Sakrawati, the Clinic at Sahyog Vihar is linked with DGHC Dwarka sector 10 and the Clinic at Dabri Extension is linked with DGHC Dwarka sector."
Reclaiming Public Services: How cities and citizens are turning back privatisation. Against the grain: New pathways for essential services in India.[24]
"The significant number of patients flocking to these clinics takes the AAP government closer to its promise of providing free primary health care to all citizens in Delhi. The Mohalla clinic model is being closely watched in health policy circles across the country and abroad. With further improvements, that eschew the current reliance on the PPP approach, it does have the potential to trigger a departure from the dangerous and expensive reliance on the private sector, and to prove that a publicly financed and publicly provisioned primary health care system is the most appropriate route to universal health care."
THE WIRE undertook an independent field study of twelve Mohalla Clinics in North and North-west Delhi and interviewed 180 patients. Primary Survey by - Reetika Khera, IIT Delhi[25]
"Mohalla clinics are making primary health care services accessible to groups with modest income; females, particularly housewives, thus helping bridge the gender gap when it comes to accessing health care facilities. About 72% of the patients in our study are females. Around 83% of the patients come from families with an annual income of less than Rs 2.5 lakh."
"Mohalla clinics have played an important role in reducing the out-of-pocket expenditure of people. Around 80% of our respondents reported a decline in their medical expenses after they visited Mohalla clinics for treatment. Also, because the clinics are situated in the locality, the commuting time has reduced for almost 77 % of the patients. About 89% of the respondents came to the clinic on foot. As a result, their travel expense has also witnessed a decline. It took them, on average, 10 minutes to reach the clinic."
In Conclusion "Mohalla Clinics are delivering good result in terms of equality in accessibility and affordability of primary healthcare. Since these clinics are mostly located in underdeveloped areas with poor infrastructure, they are ensuring better geographical access to health services. These clinics are also reducing time and costs involved in commuting and waiting to avail the treatment. This in turn, seems to give weight to the argument that supply-side financing strategy, like the one implemented through Mohalla clinics, is more rational than the demand-side strategy of financing health insurance."
Architectural Digest - Post-industrial waste to a medium for universal affordable healthcare. Author: Aditi Maheshwari, Livingetc, London[26]
AAP led Govt partnered with Design firm Architecture Discipline to build Mohalla clinics with upcycled shipping containers, for the Government’s Aam Aadmi Mohalla Clinics programme.
The containers salvaged in Delhi and Haryana, Two 20-foot-long containers are joined together to form a single clinic that includes an examination room, a reception and waiting area, a pharmacy accessible from the outside, and a washroom. The clinic is fully equipped to support routine health checks, testing, and medicine purchasing. design capitalizes on the structural strength of a discarded shipping container, and works with it as a module, reducing the need for costly modifications or custom-built additions.
The interiors are pre-installed with electrical fixtures, air conditioning, insulated walls and furniture. Anti-microbial vinyl flooring and medical-grade stainless steel countertops are also designed for easy maintenance.
IDinsight, a partner in the Initiative. Supporting the Government of Delhi to improve primary healthcare via the mohalla clinic programme.[27]
IDinsight worked closely with the Department of Health and Family Welfare, part of the Government of Delhi made these observations based on its research - "Once the patients visited a Mohalla Clinic, though, they reported receiving services that were either at par or better than other Private Medical facilities, and 97% of mohalla clinic patients stated that they would return for treatment."
IDinsight while publishing its detailed study also recommended the following actions to strengthen the program:
1. Increase awareness of mohalla clinics in the area through localized campaigns or by making it easier to locate clinics using their geo-coordinates.
2. Test interventions that can shift people towards mohalla clinics from other higher-cost primary health care facilities.
3. Further patient satisfaction at mohalla clinics through regular monitoring of quality of care and improving infrastructure at the clinics.
Original article: https://www.youthkiawaaz.com/2023/06/mohalla-clinics-20-research-studies-validate-the-success
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https://www.thehindu.com/news/cities/Delhi/Kofi-Annan-praises-mohalla-clinics/article17105541.ece ↩︎
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https://academic.oup.com/heapol/article-abstract/38/6/701/7156522 ↩︎
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https://journals.lww.com/jfmpc/Fulltext/2020/09120/Access,_utilization,_perceived_quality,_and.10.aspx ↩︎
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https://www.bhu.ac.in/research_pub/jsr/Volumes/JSR_65_04_2021/5.pdf ↩︎
https://www.frontiersin.org/articles/10.3389/fpubh.2023.1160408/full ↩︎
https://epress.lib.uts.edu.au/journals/index.php/cjlg/article/view/6987 ↩︎
https://www.academia.edu/33222965/A_Review_of_Mohalla_Clinics_Policy_of_New_Delhi_India ↩︎
https://www.ijcfm.org/article.asp?issn=2395-2113;year=2022;volume=8;issue=1;spage=18;epage=22;aulast=Virmani;type=0 ↩︎
https://serialsjournals.com/abstract/25765_9_-_ritesh_shobhit.pdf ↩︎
To Be Found ↩︎
https://www.tni.org/files/publication-downloads/reclaiming_public_services.pdf ↩︎
https://thewire.in/health/are-mohalla-clinics-making-the-aam-aadmi-healthy-in-delhi ↩︎
https://www.architecturaldigest.in/story/delhi-mohalla-clinics-made-of-upcycled-shipping-containers-promise-impact-sustainability/ ↩︎
https://www.idinsight.org/article/supporting-the-government-of-delhi-to-improve-primary-healthcare-via-the-mohalla-clinic-programme/ ↩︎
