Mohalla Clinic cum Portable Cabins: One of the Emerging Health System Models

Introduction

The Mohallaclinic cum Portable Cabins healthcare model refers to a system where healthcare services are delivered either in either in clinics that are prepared by converting locally available rooms in the streets or inside a modular structure construction. It has been envisaged as Pre-Engineered Insulated Box Type Re-Located Structures (Portable cabins) to be manufactured and installed through the Public Works Department [1]. The new Mohalla clinic is assembled and disassembled quickly and needs little space. It also fits into very tight spaces. It has beautification with modular interiors. These clinics are easy and quick to build.

These clinics are of the initiatives started by the government towards accessible and quality health care services for the population living mainly in slums, unauthorized temporary houses, Jhuggi-Jhopri clusters, and rural-urban population. In these areas, the primary healthcare facilities were not fully accessible and were inadequate [1]. The different healthcare delivery systems seen in some states and union territories like India’s capital state formulated a four-tier healthcare delivery system that is as follows: -

• Mohalla Clinic cum Portable Cabins {for primary health care}
• Multi-speciality cum Poly Clinic {for secondary health care in the form of outpatient department (OPD) consultation by specialist doctors, including laboratory diagnostics}
• Multi-Speciality Hospital {for inpatient department (IPD) care, earlier called a ‘Secondary Level Hospital’}
• Super-Speciality Hospital {earlier called ‘Tertiary Level Hospital’}

The sole purpose of this initiative is to improve the healthcare system and boost primary healthcare facilities in urban and rural areas that lack medical infrastructure. It was targeted to provide primary health facilities to people in their neighbourhoods, focusing on people residing in poor localities. The primary objective of the Mohalla clinic is to improve public health, reduce hospital burdens, and enhance facilities in the lower strata of society. Mohalla Clinic envisions linking various domains of CHESS [2]{cleanliness, health, education, sanitation, and social sectors} strategy to enhance healthcare at the grassroots level. This health facility model became a key for reforming the health system and scaling primary health care in both rural and urban areas of Indian states [3]. The idea for these clinics stemmed from the success of mobile vans and medical units [4]. Also, to boost public health, healthcare is made affordable & accessible with free medication, consultation, and health check-ups in these clinics. These Mohalla clinics captured the attention and interest of the state-level health service delivery initiatives. The present review highlights the objective of Mohalla clinics, which helps to analyze its strengths and limitations, including advantages, impacts, and recommendations. This will become a key model for other Indian states in the healthcare delivery system. It provides an opportunity to consider this initiative a successful health model toward achieving universal health coverage in India.

Methodology

This review article is written with a prime focus on the definition, implementation, and success or failure of the Mohalla clinic. For this review, an extensive literature search was done on various data sources such as PubMed, Scopus, and Web of Science, using the keywords ‘mobile health unit’, ‘mobile clinic’, ‘community care’, ‘primary health care’, ‘urban health’,‘health system strengthening’, ‘mohalla clinic’, and ‘portable container clinic’, a summary of search strategy was givenin Table 1. The article search was limited to original research and review articles, published in journals and booksections for the last ten years.

Results and discussion

Mohalla Clinic has improved access to primary health care within the community residence within a radius of one to fivekilometer along with availability, affordability, accessibility, flexibility, proximity, and community participation [5]. They are designed to accommodate various healthcare facilities such as examination rooms, laboratories, pharmacy. This model is helpful for rural and remote areas where proper medical infrastructure is lacking. They serve as temporary or semi-permanent healthcare facilities. They can be deployed in areas affected by natural disasters, during health camps, in places far away from the local rural, or urban community, or underserved populations, and regions.

In India, the first point of contact for sick patients with the doctor is seen at the primary-level healthcare facility [6]. In urban areas, the lack of adequate space to construct health centers burdens the patient load in tertiary care hospitals. To overcome such issues, portable cabins can play a crucial role. It will help to increase the number of community clinics and accelerate schemes like “Health for all” [7,8]. An official report of the Indian government release stated that approximately 800,000 people in July 2016 were provided health services, including 43,000 tests done in five months [4]. The statistic of the Mohalla Clinic stated that on average ?500- ?2000 money is saved monthly for households of five [9].

Human resource

Each Mohalla clinic caters to a population of 10000-15000 individuals within a radius of one to five Kilometres. In one clinic, a minimum of one doctor with 2-3 helping staff like one ANM (auxiliary nurse midwife), one pharmacist cum phlebotomist, and one lab technician are placed, who work in shifts of either morning (8 AM to 2:30 PM) or the evening (2 PM to 6 PM). Some of the new interventions, like a medical backup team, are also made so that the functioning of the clinic remains unaffected [11]. Mohalla clinics cum portable cabins function at the grassroots level in offering referral services to other dispensaries and tertiary care hospitals. On the verge of the zero-cost model, all tests are done free of cost, and patient samples are taken in portable cabin clinics. Still, due to a need for proper medical equipment, testing is outsourced to some private laboratories and government hospitals [12]. The government is trying to hire more doctors and paramedical staff in these portable cabins, which has created more than 10,000 jobs for them [11].

Conclusion

Mohalla clinic cum portable cabins have brought healthcare services, free medication, and diagnostics to the neighbourhood. This will help in achieving the universal healthcare goal of “health for all” to attain comprehensive care. This concept of portable cabins helps reduce the pressure of patient load in tertiary care hospitals. It also reduces waiting time for consultation within the neighbourhood’s local vicinity. The preventing outreach services should be linked with existing health facilities for monitoring the quality assurance of diagnostic services. This will help to improve the services provided by the clinics. These portable cabins have succeeded in preventive, promotive, curative, and rehabilitative health services for all. The number of increasing OPDs and patient crowds in these clinics associated with quality care services encourages other states to adopt this model. Thus, portable cabins are a positive step towards universal primary healthcare coverage for the community. The community participation and decentralization of site selection for the construction of portable cabins will help to improve the functioning of such clinics and lastly reduces patient’s burden on tertiary care hospitals.

Recommendations

Dental, and ophthalmic services can also be included in these clinics, along with an adequate number of increased doctors and paramedics. This will help to bring quality health services to the local vicinity. Portable cabin helps to reduce the cost of travel and overcrowding in tertiary care hospitals, along with potential referral linkage becoming affordable [15]. Mohalla clinic cum portable cabin helps to monitor diagnostic care quality assurance, outreach services should be linked with existing health facilities. This will help to improve ongoing services provided by the clinics. Portable cabin installation should be considered more for replacing the burden of rental space premises. Local residence spaces and barren plots in the government development authorities can be converted to construct Mohalla clinics. Portable cabin installation requires limited space to construct the basic health facility infrastructure.

Distribution of condoms and sanitary pads automatic vending machines should be installed at each Mohalla clinic cum portable cabins along with a provision of health counsellors and displayed information, education, and communication (IECs). Purposes like- capacity building among medical professionals, promoting medical skills, short-term health courses such as first aid, workshops, and volunteering activities towards safe health and personal hygiene, these portable cabins became a huge success place.

References

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