Abstract
Mohalla Clinics (MCs) were the primary healthcare service setups started in the Mohallas, 1 the innermost densely inhibited, yet unserved urban neighbourhoods of National Capital Territory of Delhi. Established under the Mohalla Clinic Scheme, 2015, by the State’s government, there were 300 such clinics offering free of cost diagnosis, consultation, medicines and pathological testing services to low-income patients without a formal health insurance coverage. The healthcare operations of MCs had been backed by many innovations such as fee-for-service pay- ment 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 centres in the national Delhi. MC had earned recognition from global public healthcare experts as a scalable and sustainable healthcare model by achieving its goal of providing universal health coverage. Service blueprint framework adopted for examining the service design of MC is presented in Figure 1.
The Proposed Solution
It was purported that MCs have worked towards reducing household out-of-pocket medical expenditures and reduction in the workload of secondary and tertiary services in the capital state of Delhi. Nevertheless, the implementation of MC scheme was confronting several operational-level challenges associated with adequate staffing, location and inventory management. Hitherto, many other Indian states expressed their interest in replicating the MC scheme for delivering affordable healthcare to low-income population. Global public healthcare experts had also advocated the extension of Delhi’s MC model to other Indian states and countries underserved dense population and privatized healthcare services. Like Ramesh, there was a vast urban population in need of an affordable primary healthcare across the various states of the country. Given the current accomplishments and challenges of MC model at Delhi, what remains to be evaluated was whether MC would turn out to be a sustainable solution for delivering primary healthcare to low-income patients falling outside health coverage,andwhether MC was a scalable model for primary healthcare delivery across other states? Table 1 presents the summary.
Service Design Elements of MC.
Public Healthcare System in India
Strengths, weaknesses, opportunities and threats or SWOT analysis of Indian public healthcare system is presented.Figure 2 presents the SWOT analysis.
Mohalla Clinic: Operational Challenges
Action Items for Overcoming Challenges
Political leadership and ownership for the service idea:
MC is a flagship scheme of Delhi state government to strengthen the public healthcare services. It is part of electoral promises to setup a four- tier healthcare system in the state with MC as the base.
Establishment of an effective performance monitoring and evaluation system:
Well-defined guidelines for the empanelment of private physicians and paramedical staff. Service quality of empanelled physicians is monitored and controlled by the Chief District Medical Office of the district. Health data collected by the Swathaya slate is used to analyse the healthcare situation in an area.
Mechanisms for active engagement of both implementors and beneficiaries:
Engagement of private doctors on fee-for-service basis. Engagement of residents and resident welfare associations in the site selection for MC.
Linkage to broad health policy:
MC is a health reform for accelerating progress towards universal health coverage in India.
Strategies for integration with existing services:
MC provider referrals to empanelled private clinics for specialized diagnostic services. However, a fully functional referral system from MC to secondary and tertiary healthcare services in the state is yet to be established.
Service package offered at a facility to be agreed and defined:
MC has an assured package of services which include out-patient consultation, first-aid services, pathological tests, routine immunization and family planning. MC also offer referrals for specialized medical services.
Financial requirement to be estimated and approved by the concerned department:
Higher budgetary allocation to health sector. A sizeable part (4%) of state health budget is dedicated for setting up MC.
Detailed operational plan:
Lack of a comprehensive operational planning for handling MC issues related to administration, technical and financial. Building infrastructure such as training, technical resources and delivery systems to support implementation Limited evidence for infrastructural support in terms of training and technical resources. Shortage of paramedical and other staff is indicative of lack of infrastructure. Evidence on support is in terms of assembly and installation of portacabins by Public Works Department.
Flexibility for adoption of innovative approaches to address the challenges of established system:
Adoption of several technology-driven innovations to address challenge of patient waiting time and to enhance service quality. Figure 3 summarize the operational planning and administrative structure related issues of MC.