1

Free primary healthcare for all – a replicable model for the whole of India

India / Freedom for Health / 4 sep 2018

India has the largest population in the world without effective health coverage. Around one billion Indians are at risk of financial hardship from healthcare costs, and in 2011 it was estimated that 60 million people were plunged below the poverty line due to their health expenditure. The level of government health spending in India is one of the lowest rates in Asia. In the absence of adequate public financing, people frequently have to pay for health services themselves, mostly in the form of out-of-pocket payments, which accounts for 62% of total health expenditure. This means people suffering from ill-health not only have to deal with the hardship caused by their ailment, but also the tremendous cost of treatment. High costs also prevent sick people from seeking treatment, which can mean their condition worsens and eventually requires a more expensive and high-risk intervention.

The state government of Delhi has been making big changes to reverse this. They have been implementing life changing health reforms since 2015, including impressive changes in primary healthcare. The government has invested in opening Mohalla (neighbourhood) clinics in poor areas of the city. These clinics are staffed by a doctor and provide a wide range of diagnostic tests and medicines – totally free of charge for anybody choosing to access them. There are currently 164 such clinics across the state which have served more than 2 million residents.

Dr Uday from Trilokpuri Mohalla Clinic describes the clinic as a place that no one will be turned away from. “The treatment and medication are free of charge. People from all sections of society come here; it doesn’t matter if they are rich or poor.” Not only do the Mohalla Clinics benefit their patients by eradicating out-of-pocket costs, but they also free up hospital space for those with more urgent health conditions. Patients visiting the Mohalla clinics are assessed by a doctor and can be referred to a tertiary service if necessary, providing a vital defence against the escalation of illness.

Delhi’s Mohalla Clinics may prove a good model to scale up Universal Health Coverage (UHC) across the whole of India. This would have tremendous effects for key health outcomes, such as increasing life expectancy and reducing child and maternal mortality rates. Importantly it would also achieve a reduction in health inequalities across different population groups, for example between the rich and the poor and between rural and urban areas. Furthermore it would also be the best way to protect the population against infectious diseases such as Tuberculosis, HIV, Malaria, Ebola and new strains of influenza.

Health in a human right and everyone deserves access to healthcare without the risk of suffering financial hardship. The Mohalla clinics provide a shining example of how government investment in healthcare can reap remarkable benefits for all, so that patients are able to focus on recovery, rather than worrying about how to pay the bill.