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Reconfiguring Urban Primary Healthcare
The Aam Aadmi Mohalla Clinics of the Delhi government have received national and international attention for their unique public health service delivery design. From April 2016 to March 2017 they delivered over 31 lakh free outpatient consultations at an average cost of `94 per consultation. This paper provides first-hand information and insight into how the clinics were operationalised in terms of infrastructure, human resources, laboratory services, medicines, and technology. It analyses their utilisation, financing, strengths and challenges at the operational, administrative and political level, and discusses how, in low-income settings, urban health systems can be strengthened using this model to expand primary healthcare services.
The authors have been associated with the mohalla clinics of Delhi.
The views expressed in this paper are those of the authors and not the organisations to which they are affiliated.
The authors thank the various reviewers and the anonymous referee for their useful comments and suggestions towards improving this paper.
Improving healthcare is a key determinant of economic development in a rapidly urbanising India. The number of towns increased from 5,161 in 2001 to 7,935 in 2011, and urban population increased from 28.6 crore to 37.7 crore, constituting 31.16% of the total population (GoI 2011). As of 2018, 35% of urban population of India lives in slums (World Bank 2021). Public health services in urban areas are fragmented and governed by multiple agencies of the central and state governments, local municipal bodies and others with little inter-agency coordination. The National Urban Health Mission launched in 2013 did not address the fundamental design defects and could only marginally impact urban health in India.
The Aam Aadmi Mohalla Clinics (AAMCs) in Delhi received national and international media, and academic and political attention (Lahariya 2017; Kant 2017; Basu and Barria 2018). This paper describes the operational aspects of the AAMCs related to infrastructure, human resources, laboratory services, medicines, technology, management systems, workflow, community participation, etc. It analyses utilisation, financing, strengths and challenges, and summarises the learnings for public purchasing of primary healthcare at the doorstep. It is based on data available from March 2016 to April 2017, the period during which the authors were associated with setting up and operationalising the AAMCs.
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