Delhi’s Mohalla Clinics created quite a stir when the first one was opened in Peeragarhi in 2015. During the Aam Aadmi Party’s first year in office, the clinics were started to take diagnostics and treatment of simple ailments to people’s doorstep and reduce the footfall in tertiary care hospitals. Mohalla Clinics have been promulgated as an unprecedented step towards mitigating the stark divide in healthcare delivery across regions and class through the means of free consultation, free medicines, and free diagnostics and pathological tests.
This “Zero Cost Model” has been touted to ensure better access to primary healthcare and reduce out-of-pocket health expenditure, amongst people coming from low-income groups and underdeveloped areas within Delhi. However, at the same time opposition political parties have criticised the clinics for being marred with corruption and poor outreach.
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To assess the veracity of these claims and take stock of the situation on the ground, we undertook an independent field study of twelve Mohalla Clinics in North and North-west Delhi and interviewed 180 patients.
Who are Mohalla clinics catering to?
Mohalla clinics are making primary health care services accessible to groups with modest income; females, particularly housewives, thus helping bridge the gender gap when it comes to accessing health care facilities. About 72% of the patients in our study are females. Around 83% of the patients come from families with an annual income of less than Rs 2.5 lakh.
Shanti, 38, who works as a domestic help suffers from diabetes. She is the sole bread earner in her family of two children. Earlier, visiting a government facility for measuring her sugar level and collecting medicines used to be a harrowing experience for her. She had no one to accompany her to the doctor and getting the test done and buying medicines burned a hole in her pocket. She therefore avoided visiting the doctor until the glucose levels were too high to go unmonitored.
Now with the Mohalla clinic in her neighborhood, she gets her sugar levels measured on a regular basis. Also, with the nearness of the clinic and free medicines at her disposal, she is able to save the money that was earlier spent on commuting and buying medicines.
It is also important to take into account the kind of ailments that are being treated in these clinics. 43% of the cases observed in our field-study were seasonal and minor ailments, followed by cases of pain (26%) and chronic diseases (21%) as shown in Figure 2. These numbers make more sense when seen in conjunction with the effectiveness of the medicines. Majority of our respondents (68%) reported that the treatment they received was effective in curing their ailments. About 8% of the patients did not find the treatment effective at all. Most of these were pregnant women for whom very few provisions are available in the Mohalla clinics to cater to their needs.
Change in out-of-pocket expenditure
Mohalla clinics have played an important role in reducing the out-of-pocket expenditure of people. Around 80% of our respondents reported a decline in their medical expenses after they visited Mohalla clinics for treatment. Also, because the clinics are situated in the locality, the commuting time has reduced for almost 77 % of the patients. About 89% of the respondents came to the clinic on foot. As a result, their travel expense has also witnessed a decline. It took them, on average, 10 minutes to reach the clinic.
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Babu Ram, 42, a migrant rickshaw puller from Bihar and resident of Vikasnagar Extension has high blood pressure and needs regular medication. He earlier visited a government dispensary, but its functioning was sporadic. He was often forced to visit government or private hospitals for checkups and medication. To do this, he had to forego that day’s earnings and spend long hours waiting for his turn as well as for purchasing the medicines from the medical stores. But now, Babu Ram says he can visit the Mohalla clinic on any day of his choice, consult the doctor and get his medicines free of cost. He does not lose that day’s work.
The way forward
Based on our assessment, Mohalla Clinics are delivering good result in terms of equality in accessibility and affordability of primary healthcare. Since these clinics are mostly located in underdeveloped areas with poor infrastructure, they are ensuring better geographical access to health services. These clinics are also reducing time and costs involved in commuting and waiting to avail the treatment. This in turn, seems to give weight to the argument that supply-side financing strategy, like the one implemented through Mohalla clinics, is more rational than the demand-side strategy of financing health insurance.
However, notwithstanding the achievements of Mohalla clinics, there are certain policy gaps that need to be addressed in the near future. First, the Delhi government has reduced the budgetary allocation for the clinics from Rs 403 crore in 2018-19 to Rs 375 crore in 2019-20. This might be translated to a reduction in the availability of essential medicines at the clinics. Currently, the Mohalla clinics have very few provisions for pregnant and lactating women who constitute a major chunk of the patients.
Finally, there are speculations that only patients with a valid residential address of Delhi, as proved through an Aadhaar card, will be treated in the clinics. This could be a huge blow to the primary idea of providing universal healthcare to the underserved population of Delhi. Migrant and seasonal laborers like Babu Ram will be the worst affected by this decision.
Acknowledgements
We would like to express our gratitude to Reetika Khera at IIT Delhi for supervising the project and providing financial support for the primary survey. Thanks are also due to Pranav Jain, associate, Delhi & NCT government, field monitors Sunil and Rishi and Angarika Rakshit, Nishant Singh, Diti Goswami, Parul Gupta and Abhigya Pandey.
Taniya Sah, Neha Bailwal, Rituparna Kaushik are research scholars at IIT Delhi. This article is the result of an independent study undertaken as a part of their coursework and does not represent affiliation to any political party.