Delhi's Mohalla Clinics - The Big Data Opportunity

Though touted as a crucial stepping stone towards achieving universal healthcare coverage, Delhi's Mohalla clinics have been subject to more political scrutiny than research since their inception. Claims about their effectiveness remain largely qualitative in nature.

One often comes across the prototypical WhatsApp forward of an exemplar Mohalla clinic facility - spick and span, thronging with patients. Frequent visits by venerable global figures like former UN Secretary-General Ban Ki-Moon in recent years have furthered credibility. Moving beyond such razzmatazz, data from these clinics can shed much-needed objective light on the effectiveness of Mohalla clinics, as I saw during a research undertaking early last year. Viewed by OPD (Outpatient Department) visits without demographic granularity, Mohalla clinics recorded roughly 61.5 lakh patient visits (distinct visitations, not patients) in the first two years of functioning. Over this time frame, almost 9 lakh medical tests were prescribed, which, for a period overlapping demonetization and a time of absolute occupancy slump across medical institutes, is formidable. The 61.5 lakh patient visits figure is almost a third of the population of Delhi As of November 2019, that figure has been updated by the Delhi Government to around 1.6 crore. Given that clinics are predominantly located in pockets that cater to the urban poor, one would surmise that many of these visits are outcomes of recurring touchpoints between citizen and formal healthcare. The linear trend of increasing patient visits over time seems to suggest that devoting unhindered resources towards setting up the remaining 750-odd clinics can reap tangible benefits as more and more of the traditionally underserved begin to embrace the Mohalla clinic model as commonplace. With 80% of patients either women, children under 16, or senior citizens, the takeaways in microcosm are: the clinics' neonatal and childcare services must be leveraged frequently, unhindered healthcare access is now a reality for citizens in dotage, and the notion of community-based health milieus as intrinsic to high-quality primary care is being ingrained into Generations Z and Alpha like never before. 

Patient costs incurred in travel or opportunity such as lost wages are only minimized by strategic Mohalla clinic locations spatially covering over 80% of Delhi's assembly constituencies. Decongestion of larger hospitals and more specialized facilities with simultaneous redirection of patient traffic towards Mohalla clinics inevitably leads to the relaxation of hefty charges, coupled with an augmented capacity for those facilities to focus on specialized care. 

J-PAL - Abdul Latif Jameel Poverty Action Lab (founded by Nobel laureates Abhijit Banerjee and Esther Duflo) recently signed an MoU with the Delhi Government for real-time monitoring of public services like Mohalla clinics. With a rich repository of clinic data and research on evaluating public healthcare from the founders of J-PAL, the collaboration promises to take data-driven governance a notch further. While patient/test numbers alone exist in a vacuum, the upcoming 2021 Census will yield rich district-level health data against which to benchmark the performance of these clinics in accomplishing tangible public health goals. Data at these clinics records diagnoses and corresponding symptoms for visiting patients entered by the consulting doctor. By mapping symptoms to diagnoses and discerning recurring clinical patterns within sub-populations, artificial intelligence models can be trained to suggest diagnoses to doctors at clinics - adding a more sophisticated dimension to diagnostic information. The key affordance of this idea is that as more and more data is collected, its patterns and underlying associations can begin to predict and inform "likely" outcomes for future patient visits. An impetus to healthcare innovation will only be a natural consequence, with room for technology companies at the cutting-edge of digital health to be integrated into this data-driven framework. Within reasonable constraints on the rights and ethics of citizens, extracting real world evidence could become almost second nature to governance processes. Needless to say, an ethics committee of sorts could oversee legitimate access to data. Better yet, a clear data protection, identity and access bill is a feasible way forward that is agreed upon by political stakeholders in our ecosystem as well. The prospect of stipulations within the recent Data Protection Bill applying here is a separate piece altogether.

Cloud computing infrastructure, which makes it possible to store large amounts of proprietary data securely over remote servers and retrieve them on demand has ushered in an era of scalability, productivity and cost-effectiveness for data processes. Leading cloud providers with robust operations in India can be roped in to expend resources aimed at driving the project. And the fact that Mohalla clinics are slated to become free wireless internet zones with the upcoming installation of hotspots across Delhi only makes a data hub more workable. 

The revised regulatory pathway for clinical trials released by the Ministry of Health & Family Welfare, a provision of which confines the approval process to 30 working days, is an ideal complement - patient needs and eligibilities can instantly be gauged from relevant queries of the data hub for more targeted drug development and related clinical studies. What's more, this would render a perfectly synergistic effort between the Delhi and central governments. Precise and up-to-date information about "medically" similar patients from previous visits can become a go-to apparatus in reinforcing physician expertise, or in closing a know-do gap (the hypothesis about physicians' inadequate action in a public setup owing to limited incentives) for preventive action. 

It is also foreseeable for such data to generate actionable managerial insights on physician performance, paving the way for a new avenue through which to incentivize doctors to keep striving towards the mission of scaling quality healthcare to Delhi residents. For a government that has been steeped in embracing technology as crucial to good governance, as is evidenced by schemes like the common mobility transport card, expansion of the electric bus program or commitment to ensuring widespread internet access, a data hub to optimize primary healthcare provision could very well come to fruition. In fact, at Mohalla clinics today, doctors feed patient interaction data into tablets, a practice that many of them have come to adopt widely over pen-paper logging. 

On the other side of incessant political mudslinging over Mohalla clinics lies the realm of actual possibility. 

Arjun Soin is a recent undergraduate in Economics Honours & Masters student in Computer Science at Stanford University, California. He's just completed a quantitative research project on Delhi's Mohalla clinics (at Stanford University) in collaboration with the Delhi Government.

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