By Shruti Appalla
Gro Harlem Brundtland, the former Director General of the World Health Organization, lent her support to the concept of Mohalla Clinics, a public health initiative in Delhi. Speaking at the ongoing Prince Mahidol Award Conference at Bangkok, Thailand, she lauded the efforts of the Delhi State government. The healthcare reforms being undertaken in Delhi strike me as an excellent strategy to build an exclusive health system in India and bring Universal Health Coverage to its people, said Brundtland. The comments came after a presentation by the Minister of Health, Satyender Jain at the conference.
Towards Universal Health Coverage
Dr Brundtland has been a pioneer in the field of sustainable development and public health care. She has, in the past, stated that Universal Health Coverage (UHC) is not just desirable, but imminently achievable. She has also supported the notion that political commitment is imperative for achieving healthcare for all. In an article for BMJ Opinion she wrote, …we know that in every country, extending health coverage is an inherently political process, especially when it comes to creating an equitable health financing system. This is because UHC can only be achieved by the state compelling healthy and wealthy members of the society to subsidize services for the sick and the poor. In effect, UHC can only be reached through public financing where the state has a big role in raising revenues fairly, according to peoples ability to pay and allocating pooled resources according to health needs.
Dr Brundtland is not the only one who has appreciated the initiative. Former UN Secretary General Kofi Annan also praised the scheme this January. Writing to the Chief Minister of Delhi, Arvind Kejriwal, he said the scheme could act as an inspiration for providing primary health care all over the world.
How the initiative came to be
The Mohalla Clinics Scheme 2015 recognised that a functioning primary health care system, which is accessible within a reasonable geographical distance, is likely to take care of the majority of the health needs of the people. The same principle had earlier been accepted in Indias National Health Policy.
The Mohalla Clinics have been the Aam Aadmi Partys main agenda, besides education. To implement the scheme, they increased the State health expenditure by 50%, raised indirect taxes, and scaled reforms in budgetary allocations.
Mohalla Clinics: Addressing local health needs
These community clinics are essentially primary health care centres that offer free consultations, medicines and diagnostics. The clinics operate as single doctor Out Patient Departments. They seek to address scenarios where specialists are not needed. Over 110 Mohalla Clinics are functional across New Delhi and have served more than two million residents. They provide the much needed local health care services to low-income households. For this purpose, they are usually set up in the innermost circles of Jhuggi Jhopris.
Mohalla Clinics have reportedly reduced the burden on the secondary and tertiary health care centres like major government hospitals. Patients save on travel costs. Their accessibility has helped raise awareness about a number of treatable medical conditions which was lacking earlier. For example, Mohalla Clinics help in spreading information about ways to stop the spread of communicable diseases like H1N1, Malaria and Chikungunya. They also counsel patients about the dangers of lifestyle diseases like diabetes and arthritis. The focus is on prevention and not cure. Doctors at these clinics also help address emergency cases and refer them to bigger hospitals for immediate treatment.
Where politics and health collide
On the other hand, the plan is not foolproof. The Delhi government has faced major obstacles in land allocations to build such centres. Land allocation in the National Capital Region takes place under the Delhi Development Authority (DDA). The DDA falls under the Lieutenant Governor and in turn, the Central government’s purview. In the recent past, the political battles between the Central and the State government have made reforms time-consuming and dangerously slow. This has proven to be a roadblock in the spread of the initiative to more regions of the city.
Yet, the initiative, although populist, has the potential to act as a major platform for research into practical means that make Universal Health Coverage a reality. Mohalla Clinics deal with issues of large population, limited resources in terms of capital and medicines, and the threat of the ever-expanding black markets and corruption. All these obstacles are remarkably similar to those plaguing the health systems of many developing countries around the world.
Dr Brundtland says that local community clinics reduce the need for people to buy cheap over-the-counter medicines from private drug shops. She claims it would become one of the factors driving antimicrobial resistance in India and across the world.
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