Health care in India—like the United States—is far from universal. It’s not only privatized but also deeply unequal, heavily favoring wealthy patients who have access to urban centers. According to most estimates, health insurance policies cover less than 10 percent of India’s 1.2 billion population, and the national government has mostly failed to fill in the gaps. Public spending on health care is only about 1 percent of India’s GDP, one of the lowest rates in the world.
The government of the National Capital Territory of Delhi wants to change that. Since winning elections to govern India’s capital and its environs in 2015, the upstart Aam Aadmi Party (AAP) has launched a project to offer Delhi residents free preventive health screenings through local clinics in the neighborhoods, or mohallas, where they live. As of April 2017, the territorial government had set up 162 of these mohalla clinics.
“The neighborhood delivery of services is an innovative concept where free consultation with free essential medicines and lab diagnostics is guaranteed at a location that is mostly within walking distance,” says Dr. Tarun Seem, mission director of the Delhi State Health Mission, which manages the initiative. A new patient can walk into a mohalla clinic—no appointment necessary—and receive a full physical examination from the doctor on staff. The clinic offers all consultations, screenings, lab tests, and medications free of charge, and asks the patient to register on a handheld tablet for follow-up visits. Patients referred to a specialist or hospital can receive those services for free, too.
The mohalla clinics themselves keep only 120 different basic medications, which the capital territory government replenishes regularly. “The doctor is really a dispensing doctor,” says Seem. “There are no procedures undertaken at this level.” The clinics also don’t provide dental care, a service unavailable at the primary care level in most parts of India.
Despite offering only the basics, the mohalla clinics meet an important need for less wealthy Delhi residents. “Like in America, we have the problem that the private health insurance industry is an influential lobby,” says Reetika Khera, an associate professor in the humanities and social sciences department at Indian Institute of Technology Delhi. Without social security and with an unregulated private sector, the wealthiest have access to top doctors, and the poorest lack access to the most basic of preventive services, such as annual physical checkups, she says.
The AAP-led territorial government originally aimed to open 1,000 mohalla clinics by the end of 2016 but has had to adjust that deadline multiple times amid a series of administrative and political shakeups, and conflict with the national government’s ruling party, led by Prime Minister Narendra Modi.
Despite these setbacks, the clinics have gained international support. Last year, the US Agency for International Development announced that it was partnering with the clinics to streamline operations and avoid extra trips to the pharmacist by installing cashfree vending machines that dispense medications based on a doctor’s prescription. Earlier this year, former United Nations Secretary-General Kofi Annan praised the AAP for using localized, preventive services to make health care more accessible and efficient—a strategy that UN agencies such as the World Health Organization support as a way to move toward universal health coverage.
Universal coverage may be a long way off in Delhi, however. Between May 2016 and April 2017, about 2,600,000 patients visited the new mohalla clinics, says Roshan Shankar, an advisor to the AAP. This is a small fraction of the capital territory’s population of almost 19 million. But it’s a substantial starting point for residents who previously did not have walkable, free, and competent preventive care.
So far, about 60 percent of the clinics’ visitors have been female and 25 percent have been over the age of 50. In providing these often-disadvantaged people services such as breast cancer detection and anemia screening, the program is helping doctors gain a much fuller picture of individuals’ health—for the first time in some patients’ lives.