Year : 2013 | Volume
: 38 | Issue : 3 | Page : 132--134
Mobile health clinics: Meeting health needs of the urban underserved
Limalemla Jamir, Baridalyne Nongkynrih, Sanjeev Kumar Gupta
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
Sanjeev Kumar Gupta
Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
|How to cite this article:|
Jamir L, Nongkynrih B, Gupta SK. Mobile health clinics: Meeting health needs of the urban underserved.Indian J Community Med 2013;38:132-134
|How to cite this URL:|
Jamir L, Nongkynrih B, Gupta SK. Mobile health clinics: Meeting health needs of the urban underserved. Indian J Community Med [serial online] 2013 [cited 2021 Jun 14 ];38:132-134
Available from: https://www.ijcm.org.in/text.asp?2013/38/3/132/116347
According to the Provisional Population Totals of Census 2011 in India, the urban population comprised 31.2% of the total population of 1210.2 million as compared to 27.8% in Census 2001.  The slum population of India in cities and towns with a population of 50,000 and above was 42.6 million, which is 22.6% of the urban population reporting slums. 
A major proportion of migrant laborers, who come from disease-endemic areas settle in urban slums with highly vulnerable surroundings (over-crowding, unsafe water, open sewers, stagnant water, poor immunity), suitable for transmission of communicable diseases and vector-borne diseases.
The situation of this vulnerable section of society is reflected in the poor health indicators. As per the National Family Health Survey (NFHS-3) findings, the Infant Mortality Rate was 42 per 1,000 live births in urban India. Stunting was present in 33% of the children under 3 years and wasting in 19%; 30% of these children were underweight. Among adults, 19.8% of women and 17.5% of men were found to be underweight. Among children aged 6-35 months, 72.2% were anemic, while 54.6% of pregnant women were found to be anemic. More than half (51.5%) the 'ever married' women in the reproductive age-group of 15-49 years were anemic. 
A study conducted in an urban slum in Haryana also found a high prevalence of risk factors (smoking, alcohol, lack of fiber intake in diet, physical inactivity, and obesity) for non-communicable diseases.  A recent study on rural-urban migrants in India have shown that migration is also associated with increase in obesity and diabetes. 
Though urban areas have better government and private health facilities, the urban poor are unable to avail them due to high cost, discrimination and perceived unfriendly environment at government hospitals, lack of information and assistance to access these health care facilities. 
In order to effectively address the health concerns of the urban poor population, the Ministry of Health and Family Welfare proposed to launch the National Urban Health Mission, with similar functioning as the National Rural Health Mission.  The government plans to place one Urban Social Health Activist (USHA) for every 2,000 population and one urban health center for every 50,000 urban population.
However, it is going to be a while till this health care infrastructure comes into being for the entire urban population. One alternative for the interim period is mobile health clinics, for the provision of primary health care to the underserved people of urban areas.
In Delhi, mobile health services were launched in 1989, with 20 mobile dispensaries, covering Jhuggi Jhopdi Clusters (unauthorized colonies of migrants) all over Delhi.  There are 90 mobile dispensaries at present, covering all the assembly constituencies. Delhi Health Services runs 45 dispensaries, while the rest are run in collaboration with non-governmental organizations. These provide health care to Jhuggi Jhopdi Clusters/unserved areas/construction sites. One mobile dispensary visits two Jhuggi Jhopdi clusters in a day. The vehicles are on hire basis, and they start from zonal offices/peripheral hospitals/dispensary cell district offices/NGOs offices. One vehicle covers total of 6 Jhuggi Jhopdi Clusters; each cluster is visited twice a week, and medicines are issued for 3 days. The team comprises a medical officer, a pharmacist, a public health nurse/auxiliary nurse midwife, a dresser, and an attendant. The services include basic medical care, health education and HIV/AIDS counseling, implementation of National Health Programs like pulse polio, measles immunization, family welfare etc., medical aid during community events (chaat puja, night shelters etc.) 
In Tamil Nadu, mobile health units were first introduced in 20 Primary Health Centers in 1977 but were terminated in the mid-1980s as the concept of mobile health units was not considered to be a progressive way of improving access to health care. Static health centers were considered a more appropriate for primary health care. However, several parts of the state continued to suffer from a lack of primary care, due to which the mobile health units scheme was revived in 2002. 
In general, the services delivered by the mobile health team are immunization, promotion of community health, including diarrhea management, antenatal care, child nutrition, family planning services, information education and communication services (disease awareness, sexually-transmitted diseases), referral and basic laboratory tests, primary medical care, mental health, and addiction counseling.
Studies have reported on the benefits of mobile health clinics. Immunization coverage increased to 80% in Gwalior, Madhya Pradesh, infant mortality declined, and the marriage age rose from 15.9 to 16.5 years.  In Bhopal, family planning increased by 14%, use of oral contraceptive pills increased by 63%, and condom use increased by 20%. 
Patro et al., studied client satisfaction with mobile health clinics in an urban resettlement colony of the National Capital Territory of Delhi.  Curative services were provided 5 days a week wherein treatment of minor ailments was provided, and specialized clinics provided antenatal and immunization services twice a week. They reported that two-thirds to three-fourths of the clients were satisfied with the mobile health care services.
Community participation is a major factor for a successful mobile health clinic service. The urban poor in India come from varied backgrounds with socio-cultural differences. Hence, resistance to avail the facilities or to reveal certain disease exposures may be present. Since referral services to an attached health facility often do not exist, patients often feel it is a futile exercise as more detailed evaluation of their illness cannot be done.
The urban poor population of India is exposed to a wide range of disease-causing agents, and the disease burden is very huge. Therefore, there is an urgent need to provide quality services with accessibility to all levels of health care facilities for all citizens. Mobile health clinics in urban areas play a vital role in providing health care services, particularly to the marginalized sections of society, for whom they are often the only source of health care. An additive objective of the mobile health clinic is to improve the access to the health system. They are often the first contact of the urban community to the health care delivery system where basic health needs are met, and for those requiring further evaluation for treatment, referral services to an attached health facility needs to be available. Till adequate accessible fixed health care facilities are made available to the under-served section of the urban population, mobile health clinics appear to be a viable option for alleviation of their suffering.
|1||Census of India 2011. Provisional Population Totals. Paper 2, Volume 1 of 2011.Rural-Urban Distribution India series 1. Office of the Registrar General and Census Commissioner, India. Available from: http://www.censusindia.gov.in/2011-prov-results/paper2/data_files/india/paper2_1.pdf. [Last accessed on 2011 Dec 11].|
|2||Burden of disease in India. Background papers for the National Commission on Macroeconomics. New Delhi: Ministry of Health and Family Welfare, Government of India; 2005. Available from: http://www.who.int/macrohealth/action/Report%20of%20the%20National%20Commission.pdf. [Last accessed on 2011 Dec 11].|
|3||National Family Health Survey (NFHS-3) India 2005-06. Ministry of Health and Family Welfare. Government of India. Available from: http://www.rchiips.org/NFHS/nfhs3_national_report.shtml [Last accessed on 2011 Dec 10].|
|4||Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, et al. Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad. Natl Med J India 2007;20:115-20.|
|5||Ebrahim S, Kinra S, Bowen L, Andersen E, Ben-Shlomo Y, Lyngdoh T, et al. The Effect of rural-to-urban migration on obesity and diabetes in India: A cross-sectional study. PLoS Med 2010;7. e1000268.|
|6||Draft for Circulation. National Urban Health Mission (2008-2012). Meeting the health challenges of Urban population especially the Urban poor (With special focus on urban slums). Urban Health Division, Ministry of Health and Family Welfare. Available from: http://www.hss.iitm.ac.in/rt-ppp/Urban%20Health/Reports/NUHM-Draft.pdf. [Last accessed on 2011 Dec 13].|
|7||Planning Commission, Government of India; Tenth Plan Document (2002-2007, Volume II). Available from: http://planningcommission.nic.in/aboutus/committee/strgrp/stgp_health.pdf. [Last accessed on 2011 Dec 12].|
|8||Mobile Health Scheme. Directorate of health Services. Government of Delhi. Available from: http://www.delhi.gov.in/wps/wcm/connect/doit_health/Health/Home/DHS/Mobile+Health+Scheme. [Last accessed on 2011 Dec 20].|
|9||Dash U, Muraleedharan VR, Prasad BM, Dash SD, Acharya, Lakshminarasimhan S. Access to health services in under privileged areas. A case study of mobile health units in Tamil Nadu and Orissa. October 2008. Available from: www.crehs.lshtm.ac.uk/downloads/publications/Mobile_health_units.pdf. [Last accessed on 2011 Dec 10].|
|10||Morrison C. India's mobile health teams set pace for progress in urban communities. Popul Concern News 1996;11:3.|
|11||Patro BK, Kumar R, Goswami A, Nongkynrih N, Pandav CS;UG Study Group. Community perception and client satisfaction about the primary health care services in an urban resettlement colony of New Delhi. India J Community Med 2008;33:250-4.|