NEW DELHI: 65-year-old Pushpa is in pain as she enters the government-run clinic near her home. She hurt her foot while chopping wood and is close to tears. The physician examining her comforts her. “Please don’t cry mataji. You will get better. Have you checked your blood sugar? You have? Ok, let me check your blood pressure,” says Dr Alka Choudhary. She is like a family physician: A polite doctor at a family friendly clinic within reach.
The clinic has brought basic health services to the doorstep of the 10,000 strong community at the relief camp and that is the model that the Delhi government is planning to replicate as it opens 100 such mohalla (neighbourhood) clinics this month.
The clinics will be the people’s first point of contact with the healthcare system and will help decongest hospitals. The first one was launched as a pilot project in July last year at the Punjabi relief camp in West Delhi’s Peeragarhi. Housed in a pre-fabricated cabin, the small and compact clinic cost Rs 20 lakh. It is open from 7 am to 7 pm and has two doctors on shift duty, a nurse, a pharmacist and a lab technician.
Durga has brought her child for his measles and DPT booster shots. “The hospital is too far, and it would take too much time. We would often wonder whether to go or not. But now, this clinic is close and convenient for us. We are regular with our checkups now,” she says.
“I have a small child. So, for common ailments like a cold or a cough I can immediately go and get the medicines,” says another resident, Seema Sharma.
The clinics offer free consultation, diagnostics, medicines, immunisation and family planning services.
Dr Choudhary explains, “Women who need to leave for work in the morning come here by 7:30 am to get their investigations done. Earlier pregnant women would be very scared and preferred going to quacks. We focused on these women and got a good response.”
The mohalla clinic is also making smart use of technology: There is a token vending machine to manage queues and a lab in a suitcase for basic diagnostic tests. Uday Pushwaha, the laboratory technician, said, “All the basic tests can be done here, such as lipid profile, kidney function test, liver function test, HBs-Ag, VDRL, blood group, haemoglobin, and pregnancy test.”
Another technological intervention is the Swasthya Slate – a tab-based medical device that can conduct a number of simple medical tests. Relevant information can be entered by the doctor, lab technician and pharmacist to ensure paperless coordination within the dispensary and with other hospitals using cloud computing. Though, The Washington Post reported the device is being used, NDTV found that the device is still a work in progress.
Dr Choudhary says, “We are not using this right now because it is still in development. So, on a daily basis we add a few things into it. It’s not being used in a full-fledged manner yet.”
“One of the issues with the tab is that it does not have the repeat option for patients’ follow up. We need an option for that. We need to be able to see previous investigations. We have asked them to add the feature or we end up going through the whole process again and again. As of now we are at 50-50 between using this tab and using paper. It will take time,” she adds.
According to Satyendar Jain, Delhi’s Minister of Health and Family Welfare, the clinic’s achievement is in strengthening the preventive and promotive aspects of healthcare. Particularly, for children. “We found that nearly 95 per cent of the patients were satisfied with their consultation at the mohalla clinic and didn’t have to be referred elsewhere. Only 5 to 10 per cent of the patients had to be referred to hospitals. This experiment has also shown how doctors can earn the respect of the community,” he says.
By the year end, the Delhi Government plans to set up a 1,000 mohalla clinics, each catering to a population of 10,000 in the city. However, since setting up of porta cabins will take till December, 100 clinics will be set up in rented rooms within a month.
Dr Tarun Seem, Secretary, Health and Family Welfare, Delhi Government, says his department is working on identifying and resolving issues like how to replenish the pharmacy or monitor the work output of the doctors.
“In the next six months, we would have figured out a lot about the kind of problems faced while running these many retail OPDs. Monitoring, management and mentoring or even supervision becomes that much more complicated. We are proposing to use IT for that. The software and the tab are being finalised. The patients are going to be identified on the basis of a unique identifier, like the Aadhar number or telephone number or election card or something,” he says.
There are other issues that need attention: The new clinics would run for only one shift because there is a shortage of doctors. The Peeragarhi clinic has staff on deputation from the National Health Mission. The staff members are on contracts that pay them less than Delhi government employees. There is obviously dissatisfaction over it.
For the mohalla clinics to succeed, the Delhi Government will have to ensure doctors show up. Delhi already has an existing chain of 260 dispensaries under the Delhi Government which over the years, became unpopular among patients because of absenteeism among doctors and shortage of medicines.