The AB-HWCs could be considered a national initiative to harmonize PHC service delivery on a common platform for all states. This is a major approach in federal system, where health is a state subject as per constitution of India. In the recent years, a number of Indian states have started initiatives to strengthen PHC services, which should provide learnings for AB-HWC and potential harmonization between state initiatives and HWCs (Box 3) [50–52, 54–58]. Clearly, for success, the Indian states have to take leadership in designing their own additional initiatives. Even when implementing AB-HWCs, innovative context specific approaches and adaptations for local setting would be needed.
Box 3 PHC strengthening initiatives by Indian states since 2015 [50–52, 54–58]
▪ Mohalla Clinics, Delhi [50–52, 54]: India’s first large scale state government led community clinics initiative in urban settings was launched in July 2015 in Delhi. These clinics, one each for every 10,000 population, are two to three room facilities with provision of primary care services including consultation by doctor with provision of nurse or pharmacist and an attendant. In addition to out-patient consultation services, there is provision of nearly 212 diagnostics tests and 108 medicines available free of cost at these clinics. Soon after launch, these clinics had become immensely popular amongst target beneficiaries and political leadership. As on March 2020, there were 480 clinics functioning with plan to set up 1,000 such clinics.
▪ Basthi Dawakhana in Telangana[51]: Basthi Dawakhana are arguably India’s first urban local body led community clinics. These have been openly claimed to be replication of Mohalla Clinics of Delhi and started by the Greater Hyderabad Municipal Corporation (GHMC). First few Basthi Dawakhana were launched on 6 April 2018. By end of November 2019, there were 115 such clinics with plan to open additional 132 in Telangana state. These clinics have been set up in close collaboration with state Govt of Telangana, Greater Hyderabad Municipal Corporation (the Urban local bodies); Mission for Poverty Elimination in Municipal Areas (MEPMA) and the union government led National Urban Health Mission. There is an improvisation on Mohalla Clinics of Delhi by provision of more services such as public health, preventive and promotive, more integrated referral system and provision of specialist services.
▪ Family Health Centres, Kerala, India [55]: Government of Kerala in mid-2017 started to upgrade and transform all primary health centres in states as part of Mission Aardram program and renamed these facilities as Family Health Centres (FHC). These facilities focus on upgrading the infrastructure, and provision of more doctors and staff, in closer collaboration with rural elected governments (Panchayati raj Institution) members. There is attention of preventive and promotive health services and by mid of 2018, of nearly 700 PHC in state, nearly 170 were upgraded to Family Health Centres (FHCs). The initial response to initiative has been very positive and utilization to most facilities has nearly doubled with wider community-based services and participation elected representatives and community members. Such facilities are also being considered as future of rural PHC in India.
▪ Community Clinics in other Indian states [50–52, 56–58]: Inspired by Mohalla Clinics of Delhi, at least a dozen Indian states or Municipal Corporations have either set up or announced similar facilities in their settings. First such clinics were started in Pune by the Municipal Corporation in August 2016. Since then Appla Clinics in Mumbai, Maharashtra (June 2019) and Atal Clinics in Jharkhand (August 2019) have been started, though, the numbers of most such new clinics is in range of 10–50 with promise for more similar facilities. States such as Punjab, Karnataka and Chhattisgarh governments have also planned to start similar clinics. Most recent addition to this list are the ‘Sanjivani Clinics’ of Madhya Pradesh, & Janata Clinics of Rajasthan, both launched in December 2019. In early February 2020, Govt of Andhra Pradesh had announced ‘Village Clinics’ for every 2,000 population in rural parts of state, which appear another promising approach to deliver PHC services in rural areas. However, success of each of these will be dependent upon how well these are implemented.