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Delhi’s “Mohalla clinic” model replicated in Bengaluru

There is a new free primary health care clinic open in Shantinagar, Bengaluru, along the lines of the Delhi “Mohalla clinic” model. I’ve heard a lot about this model so after reading about it in the paper, went along to have a look.

High quality patient-centred primary care is essential to achieving universal health coverage, and key to the success of health systems in Sri Lanka and Thailand. This is something I’ve written about before here and here.

The Delhi model has got a lot of attention within India and has been replicated in Telangana, MP, Rajasthan and Jharkhand. But it is not without criticism.

The Shantinagar clinic was clean, and open with good air flow. There were two staff nurses, a pharmacy, a clean bathroom and an MD. The clinic is open from 9-1 and offers free care, 60 diagnostic tests (through a tie-up with a private lab) and free medicines. When I was there, there were two patients waiting. People in the neighborhood didn’t know about it – we had some trouble locating it and no-one could direct us. However, the clinic only opened on Sunday so we can expect local awareness to increase.

I have previously worked as a technical advisor to the NUHM and this clinic definitely appears to be up there with the best urban clinics I have seen. The trouble with many of these urban PHCs is that they compete with a vibrant private sector (formal and informal) – which is often more proactive in giving patients what they want – for example quick relief through steroid injections, and have better local networks. This means they end up having a relatively small patient load, and the health workers are sometimes idle. I hope this clinic manages to attract good footfall. An article by Chandrakant Lahariya from the WHO addresses some of these issues around determinants of patient choice.

One path to this could be stronger community outreach. One of the criticisms of the Delhi Mohalla clinic model is that is doesn’t have a CHW cadre providing a connect to the community. They also have limited connectivity to a larger system infrastructure, and a narrow medical focus (as opposed to “health” more broadly, which would include preventive and promotive care). The doctor at the Shantinagar clinic told me that her background is community medicine, and with her expertise and guidance they are looking at ways to establish community outreach as part of the Bangalore iteration. The doctor also told me they are interested in collecting and collating patient data to understand the health status of the people in the neighborhood – but that is not currently established.

The Shantinagar clinic is funded by a trust run by Aam Admi Party members and is established as a model to demonstrate what good primary care should look like for both the public and the BBMP (the Bangalore Municipal Council), as well as a platform for political outreach. I spoke to an AAP political operative who told me about the different candidates he had in the mix for the upcoming BBMP elections (“I have an anglo-Indian lady in your neighbourhood, so that will be good for you”).

While public health is highly political – as professionals we always try to be non-partisan seeing as we need to work closely with whichever government is in power. However, during this pandemic and at time of great uncertainty and cynicism, this clinic seems hopeful. If political parties are competing to see who can provide better basic services – maybe this a harbinger of a better way of doing things.

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