MOHALLA CLINICS
Staffing: At least one qualified medical doctor, auxiliary nurse midwife, a pharmacist, and support
staff as needed
Financing: The construction cost of each clinic was estimated nearly 20 lakh Indian rupee (or US
$30,000). (However, till December 2016, majority of clinics were being operated in rented
accommodations.) Reportedly, no analysis was done on estimating the operational cost of these
clinics
Use of information technology: A token vending machine (similar to what one experience in a bank
branch) for patient queuing; computer-based record maintenance for each of the patient; and use of
tablets/software programs for prescription writing/data compilation and technology-based tablets
are used for conducting a number of laboratory tests
Leadership and governance: Initiative led by the Minister of Health and other Senior Government
officials; being implemented through specially enacted agency called Delhi Healthcare Corporation,
led by Principal Secretary (health), the top health bureaucrat in the state
Private sector engagement: The private doctors have been recruited to run these clinics at “fee for
service” basis at the rate of Rs. 30 per patient as consultation charges. If a helper is positioned, an
additional Rs. 10 per patient is paid. The fully ready chamber is made available to these doctors who
are empanelled to manage them in 4-6 h shifts as an outpatient clinic. This is small but major policy
step as most of the time, by public sector officials private doctors are seen with complete distrust
and with profit motive. That notion could only be dispelled with sustained engagement between two
sectors through top level political leadership
Timing and working days: Minimum clinic time of 4 h which can go up to 6 h. These are expected to
be open in morning; however, time of clinic can be adjusted to patient needs and a few run in
evening as well. Open six days a week excluding public holidays
Other features: A proposed strong and effective referral linkage with attention on continuity of care;
financial protection (by free services); reduced cost of care by higher attention and investment on
healthcare, ambulance and transport services
TYPE OF HEALTHCARE FACILITY
The idea: To provide free healthcare services through a health facility within a walking distance
(around 2-3 km radius or 10-15 min walking), open for at least 4-6 h of every working day, assured
availability of identified basic health services, a medicines, and diagnostic tests. Estimated 80%- 90%
of health problems are likely to be treated at this level reducing the numbers of patients in need for
referral
Physical infrastructure and accessibility: Proposed to be housed in two to three rooms. The rooms
could be either made of prefabricated material (called portacabin) or in private houses with similar
amenities. Of the rooms, one to be assigned to a doctor and for medical examination, sufficient
enough to maintain privacy. The other or second room is used for laboratory functions, dispensing
medicines, and the waiting seat for next patient to be seen by doctor. If there is a third room
available, it could be used as waiting room; else the open space covered through a roof should be
used as waiting area. The provision of drinking water dispenser and a washroom attached to these
facilities. There has to be provision of air-conditioning and a television with cable connection is part
of the design. These clinics to be located in a way to ensure easy accessibility by beneficiaries, with
an all-weather road, accessible by an ambulance, and an open area
CATCHMENT AREA AND POPULATION
Population targeted: Underserved, migrants, Jhuggi Jhopri colony; each clinic aims to serve
approximately 10,000-15,000 population
Location: Settings and localities of migrant and poor population lives and demarcated areas called
slums and Jhuggi Jhopri colony, where such underserved population lives. First such clinic was
established in North-West Delhi in Jhuggi Jhopri colony and it was situated around 400 m walking
distance from the main road, in the center of Jhuggi Jhopri settlement. The locations are decided
with inputs from local community/Resident Welfare Associations (RWA)/survey by planning
branch/verification of sites by team of health personnel
MAJOR DEPARTMENTS
Service provision: An assured package of health services include outpatient consultations, basic first
aid services, maternal and child health services including immunization, antenatal and postnatal
services, family planning, counseling, and referral to next level of facilities for specialized treatment.
These clinics aim to implement national health programs as well
Specialist and referral services and continuum of care: Specialists proposed to be available on weekly
basic (pediatrician, gynecologist, and ophthalmologist). A system of referral through a tiered
approach to health facilities been proposed (though yet to be made fully functional)
Medicines and diagnostics: Sufficient supplies of medicines and diagnostics, free of cost to the
people availing these facilities, from an approved list of 108 medicines and provision of >200
diagnostic tests
Strength
High political ownership: The state government seems committed to
provide assured quality health services to the people. These clinics have
been announced as flagship scheme alongside education sector, possibly a
first for an elected government by Indian states, to prioritize health in such
a way
Budgetary allocation: The prioritization of health and Mohalla Clinics
was supplemented by increased budgetary budgetary allocation to health
sector
Fiscal strength of the state and planning and financial allocation
linkage: Delhi has advantage of higher budgetary capacity. This initiative
is apparently has appropriate planning to intention linkage. The state has
financial ability to rope in additional doctors (one each) for these clinics,
which might not be possible for other settings even if the states have the
desire to recruit and allocate funds (due to shortage of doctors)
Equity in service delivery: Clinics targets underserved population and in
areas with limited access to health services
Large network secondary and tertiary care facilities: To absorb
referral from lower tier of health facilities However, referral under these
clinics has been proposed and yet to be made fully functional
Availability of trained human resources: Delhi has higher number
of doctors and other staff per 1000 population and the challenges in
recruitment of workforce would be financial and administrative and not
the availability
Larger target community: The poor and migrant community being key
constituency in need for health services
Responsiveness of health system: Token vending machine; medicine
vending machine
Limitations
Limited focus on public health service: These clinics, at least
till now, have focus on personal or curative, diagnostic, and a few
preventive health services
Limited linkage with community and outreach services: The
preventive and promotive health interventions based at community
should be part of the services being delivered
Limited linkage with existing mechanisms for service delivery:
There are multiple agencies delivering basic health services in the Delhi
state and unless there is improved coordination among these agencies,
the effectiveness of mohalla clinics is going to be a challenge
Comparison of mohalla clinics with existing health facilities
Existing health facilities
1 A) Health posts: Very few facilities, dependent on funding availability, Limited
package of assured services, poorly staffed, and poorly utilized by the
community members, situated not necessarily in poor and underserved areas
2A)Specialty facilities, i.e., mother and child welfare centers. Focused on specific
target populations, far and few for cities such as Delhi
3A)Mobile Medical Units (MMUs) or Mobile Vans Would go to a specific area
and provide services; mostly for underserved communities but services are
unpredictable. Limited in numbers for states such as Delhi
4A)Dispensaries and polyclinics: These are often housed in multiple rooms and
either overcrowded or underutilized or a few which are used by patients have
limited (un)assured availability of services and provider
Mohalla Clinics
1B)Assured availability of a range of services and providers, state
government’s dedicated funding, and wide network among other.
2B)Situated in slums and underserved areas,
3B)A range of personal healthcare services where any member of family
can seek basic health services
4B)Fixed site physical facility, so people know where to go for availing a
health service
5B)These clinics would be in 2-3 rooms and assured services. Efficiency in
service delivery
Suggestions to strengthen mohalla clinics and
primary health care in Delhi, India
• Develop a detailed road map and operational plan: Addressing key aspects including technical,
financial, and administrative. Government may consider making this available in public domain with
monitorable indicators and timelines
• Establish mechanisms for performance monitoring and evaluation: Use data from these facilities
for real-time analysis
• Do not duplicate even if that is politically attractive: Use the existing dispensaries either as mohalla
clinics or polyclinics. The functioning of these dispensaries should be studied and then assigned an
appropriate place in the system of health service delivery in Delhi
• Develop convergence with existing and proposed health facilities: Where mohalla clinics focus on
clinical services and other facilities such as urban primary health centers (U-PHC) of National
Urban Health Mission deliver complementary public health services
• Ensure political ownership and financial sustainability: Political ownership is required for bold
decisions and address the implementation issues in real time
• Engage with key stakeholders: Including political parties, community leaders, and councilors and
other stakeholders. Develop consensus or at least attempt to build consensus
Private sector engagement: The private
doctors have been recruited to run these
clinics at “fee for service” basis at the rate
of Rs. 30 per patient as
consultation charges. If a helper is
positioned, an additional Rs. 10 per patient
is paid. The fully ready chamber is made
available to these doctors who
are empanelled to manage them in 4-6 h
shifts as an outpatient clinic. This is small
but major policy step as most of the time,
by public sector ofcials
private doctors are seen with complete
distrust and with prot motive. That notion
could only be dispelled with sustained
engagement between two
sectors through top level political
leadership
Timing and working days: Minimum clinic
time of 4 h which can go up to 6 h. These
are expected to be open in morning;
however, time of clinic can
be adjusted to patient needs and a few run
in evening as well. Open six days a week
excluding public holidays
Other features: A proposed strong and
effective referral linkage with attention on
continuity of care; nancial protection (by
free services); reduced cost
of care by higher attention and investment
on healthcare, ambulance and
