Alisha Thapa is working as a community manager in MixORG, New Delhi. She generates content and strategy for brands. Also, she runs campaigns for brands’ engagement and presence on online media channels.

Shreya is an engineering graduate who is working with team InnovatioCuris connecting European Healthcare innovation leaders with the Indian healthcare system and pioneers. She looks forward to pursue her masters in the field of data science. Her interest areas are Indian education, healthcare and transportation.

One of the initiatives of Delhi’s government is about innovations in the healthcare delivery model Mohalla Clinics meaning Neighbourhood Clinics. This is a format of care delivery targeting to improve the access to primary care.
With the launch of the first Mohalla clinic on a trial basis at West Delhi’s Peera Garhi in July 2015, the Delhi government initiated to give an access of basic health facilities to the people of Delhi within walking distance. The first clinic head Dr. Alka Choudhary as the main doctor, an auxiliary nurse midwife, a sister and a technician. The clinic received a positive response from the common people with a recorded visit of 102 patients in just three and-a-half hours.
The government then proposed to maximise these clinics up to one thousand by 2016. However, there are less than 200 Mohalla Clinics operating at present. These clinics are set up with the aim to
1. Ease the burden on over-crowded hospitals.
2. Provide de-addiction counselling, family welfare counselling, lifestyle disease counselling and national programme counselling.
3. Zero cost on check-ups, medicines and tests.
4. Cut down the expenses on travelling and avoid long distance travelling to reach the hospitals by the poor and old-aged people respectively.
5. Immediate recovery from ailments.
At the beginning stage of this initiative, Delhi’s health minister Mr. Satyendra Jain had proposed that Mohalla Clinic could attend 80% of patients’ illnesses (20% with more serious illnesses to visit the hospitals). Mohalla Clinics have been more successful in attending patients than anticipated. the clinics were able to cater 95% of the patients’ illness. Mr. Jain also had spoken about more advancements and digitisation.
Dr Pal while attending a patient at Todapur’s Mohalla Clinic said:
The massive success of this project eventually gained the interests of other states in the country. A Mohalla clinic has been set up in the city of Mumbai in August 2016. Following the footsteps also includes the Karnataka government who announced on September 2016 to open two Mohalla clinics in Karnataka. The Gujarat Health Department decided to replicate the concept in four cities of Gujarat: Ahmedabad, Vadodara, Rajkot and Surat.
The foreign media has equally lauded the initiative. The highly honoured press journals “The Lancet” and “The Washington Post” have mentioned the initiative as a lesson for America.
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The second half of 2016 also marked another technological advancement in the Mohalla Clinics with an upgrade of a Mohalla Clinic in Todapur with a medicine vending machine, replacing the work of a pharmacist. According to the government reports, almost eight lakh patients were treated in five months in the Mohalla Clinics.

The world leaders like Kofi Annan and Gro Harlem Brundtland were highly impressed and congratulated Delhi CM Mr. Arvind Kejriwal. Both the leaders perceived the model of Mohalla Clinic not only as a country’s achievement but also a universal message to uplift the primary health care system.

During the recent visit to a Mohalla Clinic at Todapur, West Delhi by InnoHEALTH (IH) Team, met with Dr Pal, who answered some of the questions of interest.

Q.1. What is a Mohalla Clinic project?

Dr Pal: It is a pilot project with a target of 1000 Mohalla Clinics in the entire city.

Q.2. How do you operate as a doctor of Mohalla Clinic?

Dr Pal: Considering data entry, consultation, examination and prescribing medicines, on an average I spend up to four minutes on a single patient and 60-70 patients during the working period of four hours in a day.

Q.3. How easy it is to access the facilities? Can someone just walk in or they need to show some evidence?

Dr Pal: (While practically demonstrating his procedure with the help of a tab) As you can see, the patient has come for the first time, I register her details like first name, sex, age, marital status, address, mother’s name along with a picture of her clicked and then the consultation part I fill up like symptoms, examination, type of tests, prescription in the tab and finally issue a slip of the prescription.

Q.4. What makes it stand out from other healthcare projects?

Dr Pal: There are three major benefits of this project:
1. The hospitals can improve the quality of services as the load of the patients will be less because their load will be taken by Mohalla Clinics.
2. Only manifested and critical cases are going to the hospitals as patients at their early stages of illness are coming here (Mohalla Clinic) and we are giving all the possible treatments and advices within the clinic.
3. The quality of interaction between me as a doctor and the patient is more comprehensive and we are able to give a service with a personal touch to the community.

Q.5. Who is looking after the expenses of this project?

Dr Pal: It is a government project and the clinic has been set up as rented accommodation. The rent as well as medicines is provided at minimum costs. As a doctor I get INR 30 per patient, my assistant staff and multi-task worker get INR 8 per patient and INR 2 per patient respectively.

Q.6. From the time the project started till present, what is the level of success? And how do you measure the level of success?

Dr Pal: After the completion of one year, I can say the project has been successful. For instance, this area where I am operating consists of a population of approximately ten thousand comprising two thousand families. Surprisingly, almost each and every family has visited this clinic, be it for a minor or major purpose and that is exactly served our purpose. We want more and more people to visit Mohalla Clinics and get the required treatment. And not only the people of this local area but people from places like Noida, Rajasthan, Tamil Nadu, Andhra Pradesh have visited us to learn about this project, which is a proof that other states are also aware, happy and replicating the model.

Q.7. What are the criteria for the selection of doctors for this project?

Dr Pal: Doctors’ selection is done by Directorate of Health Services in the office through walk in interview. One can find the advertisements on newspapers. Doctors can appear along with the required documents and especially the retired doctors are preferred for this project.

Q.8. How often do you refer patients to the hospital for further treatment?

Dr Pal: I hardly refer 1 or 2 patients in a day and rest we take care of ourselves. Patients who are mostly at early stages of the illness come here. For instance, children are prone to disease such as pneumonia and we have been able to detect this disease at the early stage at least in this area and nobody has suffered from this illness. This is how burden of the hospitals is reduced.

Q.9. What are the changes you see in yourself?

Dr Pal: As I’m already a retired person, I’m getting professional satisfaction while working here and I’m able to keep myself fit by continuing to work.

An interaction between IH Team and patient named Pinky at the Mohalla Clinic

IH: What health problems do you have?

Pinky: I’m having high blood pressure problem and Dr Pal has been taking care of me.

IH: How often do you visit this clinic? For how long have you been treated here?

Pinky: I visit this clinic on alternate days and my treatment is going on for last one and a half months here.

IH: How do you find the treatment?

Pinky: Sir is observing my problem really well. My blood pressure test is done very often and he advises me according to the blood pressure chart.

IH: How far do you stay and earlier where were you going for your high blood pressure treatment?

Pinky: My home is quite near. The hospital, where I was previously visiting for the treatment was one hour away from my home, due to which I used to leave from home early in the morning and at times it used to be difficult to manage with my small kid. But now everything has become convenient.

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Attractions

Advantages of medical treatment in India include reduced costs, the availability of latest medical technologies, and a growing compliance on international quality standards, Doctors trained in western countries including US and UK, as well as English-speaking personnel, due to which foreigners are less likely to face language barrier in India. According to the Confederation of Indian Industries (CII), the primary reason that attracts medical value travel to India is cost-effectiveness, and treatment from accredited facilities at par with developed countries at much lower cost. The Medical Tourism Market Report: 2015 found that India was “one of the lowest cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at about one-tenth the cost of similar procedures in the United States.”

Cost

Most estimates found that treatment costs in India start at around one-tenth of the price of comparable treatment in the United States or the United Kingdom. The most popular treatments sought in India by medical tourists are alternative medicine, bone-marrow transplant, cardiac bypass, eye surgery and hip replacement. India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine.

Quality of care

India has 28 Joint Commission International (JCI) accredited hospitals. However, for a patient traveling to India, it is important to find the optimal Doctor-Hospital combination. After the patient has been treated, the patient has the option of either recuperating in the hospital or at a paid accommodation nearby. Many hospitals also give the option of continuing the treatment through tele-medicine.

The city of Chennai has been termed “India’s health capital”. Multi and super-specialty hospitals across the city bring in an estimated 150 international patients every day. Chennai attracts about 45 percent of health tourists from abroad arriving in the country and 30 to 40 per cent of domestic health tourists.

Factors behind the tourist inflow in the city include low costs, little to no waiting period, and facilities offered at the specialty hospitals in the city. Chennai has an estimated 12,500 hospital beds, of which only half is used by the city’s population with the rest being shared by patients from other states of the country and foreigners. Dental clinics have attracted dental care tourism to Chennai.

Ease of travel

The government has removed visa restrictions on tourist visas that required a two-month gap between consecutive visits for people from Gulf countries which is likely to boost medical tourism. A visa-onarrival scheme for tourists from select countries has been instituted which allows foreign nationals to stay in India for 30 days for medical reasons. In 2016, citizens of Bangladesh, Afghanistan, Maldives, Republic of Korea and Nigeria availed the most medical visas.

Language

Despite India’s diversity of languages, English is an official language and is widely spoken by most people and almost universally by medical professionals. In Noida, which is fast emerging as a hotspot for medical tourism, a number of hospitals have hired language translators to make patients from Balkan and African countries feel more comfortable while at the same time helping in the facilitation of their treatment.

Want to write for InnoHEALTH? send us your article at  magazine@innovatiocuris.com

Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2

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