“The mohalla clinic model could be an effective way to deal with the coronavirus pandemic”

These clinics can play a key role in fighting the relatively unknown enemy considering we have an overburdened health system where one doctor caters to nearly 1,500 patients

Irfan Khan
| Updated: May 1st, 2020

The world is going through one of its worst pandemics after the 1918 flu epidemic, the COVID-19 or the SARS-CoV-2. The Corona Virus Disease (COVID) has already killed more than 2.3 million people, which is 7% of the total number of people infected (nearly 33 million) worldwide. Some of the worst-hit countries are the ones most developed with a much better healthcare infrastructure than the rest of the world. It is time to think about developing nations like India in the midst of these challenging times.

Almost all states and Union Territories in India have faced the brunt of the problem to varying degrees. Till date, India has around 35,000 confirmed cases, of which around 8,500 have recovered and a little over 1,000 have died.

There is a general sense of anxiety around the impact and extent of damage this pandemic will end up causing all over the world. There is still a lot unknown about the virus, which has created a lot of uncertainty around its spread, incubation, production of antibodies and development of vaccine or drugs.

In the fight against the virus, some countries have done better than the others. Their efforts in enforcing the necessary precautionary measures, like social distancing norms and lockdowns, to contain the spread of infection and taking care of those who were already infected and those who needed to be quarantined, are being appreciated by many, including the World Health Organisation (WHO). India is one of the few countries whose aggressive approach to break the infection chain has been applauded by the WHO, given the population size, density and existing health infrastructure.

There is still a lot unknown about the virus, which has created a lot of uncertainty around its spread, incubation, production of antibodies and development of vaccine or drugs

The Government of India has been quite attentive and has responded to contain the spread of the virus by breaking the chain through initially going for a one-day Junta Curfew on March 22, and thereafter taking the course of a complete lockdown from March 24, which has been further extended up to May 3. As we approach the end of lockdown 2.0, there are researchers, scientists, epidemiologists and experts raising concerns on the effectiveness of the lockdown measures in actually preventing the spread by breaking the chain. At the same time, there is tremendous pressure on the government to restart businesses, factories and agricultural activities to prevent any more social and economic loss than what we have already endured.

Given this dichotomy and the dilemma of whether to go for another lockdown or not, and the so many unknown characteristics of this virus, we may have to explore ways to prepare ourselves to live with it, which as the things are right now, seems is going to be the new norm.

With an already overburdened health system, where one doctor caters to nearly 1,500 patients, where there is one bed between 1,850 patients and where almost 80% of the people visiting the OPD of a tertiary care hospital could be managed at smaller facilities, I think decentralising healthcare could be an effective way to deal with this kind of a pandemic. Having set up and managed them, the Mohalla Clinic model from Delhi comes to my mind as a good example of decentralised healthcare.

To understand what I mean by decentralized healthcare, I need to explain how a Mohalla Clinic works. The objective of a Mohalla Clinic is to cater to a catchment population in a ‘mohalla’ of around 1,000-1,500 with the people not having to walk more than 1,000 meters from their homes to access primary healthcare. A clinic application on the doctor’s tablet records all the details of a patient visiting the clinic and can be accessed later whenever the patient revisits the clinic.

In India, there is one doctor for nearly 1,500 patients. However, there is one bed between 1,850 patients

Over a period, almost 80% of the people living in the area would have accessed the clinic at least once thereby creating a database of almost all the people belonging to that area. It also creates a rich epidemiological data of patients’ profile and disease pattern. Each Mohalla clinic is linked to a laboratory, which collects the samples from the clinic and delivers the reports to the clinic, which are then collected by the patients.

So, how would this model of healthcare help in the battle against COVID-19?

Screening and Referrals: Since a clinic caters to a catchment population of a particular area, these clinics can be a good first contact point for screening people who might be showing the symptoms of the disease. The team at the clinic could do a thorough screening using the guidelines provided by the competent authorities and refer only those who need testing to a linked testing facility, or a quarantine facility based on their travel or contact history. This will restrict people from moving from their locality to other places for testing and treatment facilities thereby preventing transmission to other localities.

Diagnosis and follow up: The reports will be delivered to the clinic and the clients are called to the clinic to collect it. Based on the report, the following steps can be drawn up for each case. In case a client is tested positive, he/she would immediately be sent to a linked treatment facility and the family members advised to get tested and home quarantine themselves till reports arrive. This will help epidemiologists predict a more accurate disease trend and status of a locality based on the localised information gathered on the people tested and referred for treatment.

Since a clinic caters to a catchment population of a particular area, these Mohalla clinics can be a good first contact point for people for their treatment

Contact tracing: With the help of the patient and his/her family members information on people the patient might have met or was visited by others could be collected and shared with the district health authorities. They could, in turn, trace the contacts and based on their area of residence link them to their neighbourhood clinic for screening, quarantine facility or referral for testing or treatment.

Containment: In the event a particular clinic witnesses a very high number of positive cases, the district authorities can seal that area to contain the infection from spreading to other areas. The clinic team and other volunteers, in coordination with the district team, could be involved in ensuring that restrictions related to the containment zone are adhered to and people get their necessary supplies at their doorsteps.

Informed classification of zones: With close follow-up and monitoring of the cases in the area, the district authorities can declassify a containment zone and lift the restrictions. Similarly, based on the classification of different zones/areas, business and travel restrictions could be relaxed relying on more empirical data rather than on a generalised trend.

Preventive education: Most importantly, with so much unknown about the virus and with rumours and misinformation galore, such local neighbourhood clinics can become reliable and trusted sources of information. This would help in prevention activities.

There is no doubt that once a COVID-19 patient is taken ill severely, he/she would need a specialised hospital set up to provide the required treatment. However, we should not overlook the crucial and decisive role neighbourhood clinics like the Mohalla Clinics can play in fighting a relatively unknown and unseen enemy like the coronavirus.

Irfan Khan is a public health expert who, apart from working on various projects on HIV/AIDS, SRH and Family Planning, has set up the Mohalla Clinics for the GNCTD in 2016

(Views are personal)