Mohalla clinic is initiative of Delhi Government (of Aam Aadami Party).

1. Mohalla Clinics
- An Initiative of Delhi Government to Universal Health Coverage
Presented by:
Dip Narayan Thakur
Nigam Koirala

2. Background
• Delhi state, with a population of 16 million, has a fragmented
health system run by multiple state and central government
agencies and municipal corporations, as well as a range of
private providers.
• The health system of the Delhi Government alone has 36
hospitals (10,000 beds), 185 dispensaries, and dozens of other
facilities, catering for 33 million outpatient visits every year.
• Four municipal corporations run their own networks of
dispensaries. Yet many areas remain underserved, some
facilities remain underused or poorly staffed as the different
health systems are not inter-linked.
• Doctors and paramedics are also overworked and
absenteeism is high.

3. • High Level Expert Group on Universal Health Coverage
established by the central government had recommended in
2011 a substantial increase in public health financing to
provide universal access to free primary care services
including essential medicines and diagnostic tests.

4. “People of Delhi will be able to receive treatment for 99% of their
ailments near their homes. If it is a small problem, they can go to
a mohalla clinic and if specialist care is required, they can go to a
polyclinic near them. People will not have to go to tertiary care
hospitals just for consultation”
– Arvind Kejriwal, Chief Minister of Delhi.

5. Introduction
• Mohalla means ward or small community.
• ‘Mohalla Clinic’ a type of ‘community clinic initiative’, which is
being famous among residents of Delhi.
• Clinic was opened as part of a flagship programme by the
Delhi Government (of Aaam Aadami Party) launched in July,
2015.
• Mohalla clinics have added another layer to the existing health
care system.
• Initiative is aimed at expanding the reach and range of health
services in unserved and underserved areas such as slums and
elderly.
• Services are free for people from all income level.

6. At one point people get the following services*,
• Consultation (General, FP counselling)
• Medicines (110 essential drugs)#
• Diagnostic tests (212 types of diagnostics tests)
- Also provides Immunization and DOTS
• Average distance of Mohalla clinics are within 5 km distance.
(14 clinics per assembly constituency)
• Clinics run from 9 am to 1 pm (Indian Standard Time) but
some also runs in evening shift.
• Staffs at each Mohalla clinics include a Medical officer, a
pharmacists, an auxiliary nursing midwife, a lab technician and
a security guard.
• For specialist consultation and tests like eco-cardiogram, MRI,
CT scan, patients can visit 150 polyclinics.
*For the same services in pre-existing scenario, people had to visit three different level of
health facility.
#unable to find list of medicines

7. • Once the 1,000 mohalla clinics and around 150 polyclinics
come up, people will go to (bigger) hospitals only if there is
emergency or they have some serious problems and need
admission.
• Compensation for doctors and staff in mohalla clinics is
linked to the number of patients they see. (Performance
based)
• They provide an assured package of services, facilitate access
to basic services, with potential for referral linkage, and make
it all affordable by reducing indirect costs like travel and lost
wages.
• Attempted to address problems of unqualified providers and
overcrowding at tertiary care facilities.
• Document all the health records electronically and history
will be kept to share across all hospitals.

8. Key features
• Increasing Geographical Access to the Health Service
• Making Health Services Accessible
• Reducing the Cost of Care (indirect health care costs)
• Counselling and Referral Services
• New Technology to Meet Local Health Needs (like MVM)
• Highly Cost-effective Intervention
one-time cost of these 1,000 clinics (approximately Rs 200 crore) would be less
than what is needed for setting up a secondary hospital. Approximately, 2,500
mohalla clinics could be opened in the amount required to set up an AIIMS-
like institution.

9. Physical Infrastructure
• Two-room clinic (in app. 50 square yards), made of prefabricated
material (porta-cabin).
• Access for an ambulance to approach and open space around the
clinic.
• Clinic has a doctors’ room, a pharmacy, laboratory
• Testing kits and there is also a provision for a token vending
machine.
• A television set with cable connection, a drinking water dispenser,
and a waiting area with chairs.
• A clinic reportedly cost the
government Rs 20 lakh

10. How it has gone so far?
• In average 100 to 120 patients visits every day per clinics.
• There were 106 such clinics in Delhi and close to 1·5 million
patients have visited them in the past year.
• Automatic Medicine Vending Machine (MVM)#.
• Currently, 23 polyclinics which have doctors from various
specialties, are also functional.
• For this FY 2017/18, Delhi government have allocated 12%
of their budget to health sector (₹5,736 crore) which is
marginal increase than previous years.
• The government has tied up with 21 private laboratories to
provide 13 expensive tests such as MRI, CT scan, PETCT
which are either unavailable or have long waiting periods at
the government hospitals.
#A Joint Initiative of Delhi Government, USAID and WISH

11. • Four clinics at night shelters is helping screen the homeless
and marginalized, who often get left out of social benefits.
• After launching the first of their promised 1,000 mohalla
clinics last month, the Delhi government will be launching
another project to help reduce the gap between hospitals
and the people — this time for young children.
• Conduct house-to-house surveys in slums and JJ colonies to
collect information on children under five. Officials will
conduct health checkups and necessary treatment will be
provided in government health facilities if any ailment is
identified.
• The government is looking at strengthening its four tier
system – mohalla clinics, polyclinics and the multispecialty
and super-specialty hospitals.

12. WISH and Mohalla Clinic
• WISH stands for Wadhwani Initiative for Sustainable
Healthcare.
• It is the Knowledge and Management Partner
• In partnership with the government WISH has developed an
android based application for the clinic management which
transforms the work process of a public health facilities by
 Online registration of patients;
 Inventory management;
 Lab management;
 Invoicing and
 Reporting and data analytics.

13. Plan For Universal Insurance in Delhi
• Formed eight member Society for Universal Healthcare in
Delhi chaired by state health minister.
• Depending on the socio-economic condition, the premium
of the insurance will vary between Rs 0 and Rs 2,000- Rs
3,000 per annum. (Aam Aadami Swasthya Bima Yojna)
• Family insurance scheme will cover services of up to 1 lakh
for almost all illnesses that require hospitalization and Rs 2
lakh – Rs 4 lakh cover for critical illnesses.
• The list of critical illnesses will include 1,700 – 1,800
conditions.

14. Mohalla clinic drawing international praise
Kofi Annan, chair of The Elders (Former Secretary-General of
United Nations)
• “This project….provide further important lessons for other
Indian states embarking on the UHC (Universal Health Care)
journeys”
• ‘The UHC policy memorandum -- containing suggestions to
scale up the primary healthcare services’ to CM of Delhi by
‘The Elders’.
 PHC is more than treating illness -- it should also involve
services to prevent people falling sick.
 Improve management information systems for maintaining
patients’ records and better monitoring.

15. • Dr. Gro Harlem Brundtland, former director general of
World Health Organisation
 In Delhi, 110 clinics have treated 1.5 million people
between April and December, shows latest available
data. “This indicates the huge unmet need for free
universal health care. The health care reforms being
undertaken in Delhi strike me as an excellent strategy.

16. Critiques
• Under pressure from populist politics, these clinics are
ending up equating holistic health care with curative care
however preventive outreach services, linkage with existing
health facilities, and monitoring and quality assurance of
diagnostic services could help improve the services being
provided by the clinics.

17. Challenges
• Scale up has caught up political dispute.
• The clinics during the pilot stage were opened in rented
premises. Now we want to install portable cabins on public
land but central government, which controls all [of the] land
in Delhi, is cold to the idea
• The plan to use parts of government school buildings is
also facing bureaucratic hurdles.

18. Mohalla Clinics and NCDs
• Narayan Das used to run a roadside bicycle repair shop near
a slum in Sultanpuri, northwest Delhi. He was not aware of his
high blood sugar levels until he collapsed at work and had to
be admitted to hospital.
“After my diabetes was diagnosed, I began spending about 200 rupees
every month on medicines and regular blood tests. This was a heavy burden
as I had retired from work”
• Now, he does not have to worry as he gets regular
medication and blood sugar tests done for free at a mohalla
clinic (community clinic) not far from his home.
A Case Story

19. • It will reduce financial burden on patient party for long-term
treatment and lab tests of NCDs.
• BUT as we know, it’s poor part is lack of incorporation of
preventive and promotive components, which could reduce
the risk of NCDs and ultimately reduce financial burden on
government.

20. What can we do in Nepalese Context
• Political will like of Delhi government is must.
• Free package of service should expand to cover more
diagnostics and drugs.
• Should incorporate preventive and promotive activities.
• Location of health center should be near to underserved
and unserved population like slums. Evening shift for busy
people is needed in urban setting.
• Knowledge and management partners is needed (as of
WISH for Mohalla clinics)

21. References
1. Seven things to know about Delhi’s mohalla clinics praised by world
leaders, Hindustan Times.
2. Delhi’s Mohalla Clinics: maximising Potential, Chandrakant Lahariya,
Economic & Political Weekly, Jan 23, 2016
3. Delhi looks to expand community clinic initiative, Dinesh C Sharma,
The Lancet, Vol 388, December 10, 2016
4. Mohalla Clinics: Kofi Annan praise fine, but will Delhi govt fix these 4
issues?, Hindustan Times, Feb 20, 2017
5. he Elders urge bold steps to reach Universal Health Coverage in
India, Press Release, The Elders, London, 26 January 2017.
6. AAP govt forms committee to help provide insurance to all,
Hindustan Times, Aug 21, 2016

22. Thank you