Abstract
The Mohalla Clinic (MC) scheme was launched in Delhi, India, to provide primary healthcare services accessible to underserved populations at their doorstep. Starting with one clinic in 2015, the scheme has expanded to 518 clinics today and more are planned. While studies have documented the success of the scheme and its popularity among beneficiaries such as the elderly, children, women, and migrant populations, there is limited research on how the environmental design of MCs impacts the quality of healthcare delivery. This is especially relevant as many MCs have been converted into COVID-19 testing centers. Therefore, this qualitative research investigated how environmental design changes necessitated by COVID-19 impacted healthcare delivery in MCs. Field studies were conducted in two phases. First, a rapid ethnography of 24 MCs was conducted followed by semi-structured interviews with thirty-five medical staffs in nine MCs. Findings suggest that environmental design changes negatively impacted healthcare delivery. Space accessible to the patients was reduced by 66%–75%, exterior openings were reconfigured to offer healthcare services, covered waiting spaces were inaccessible, restrooms and drinking water facilities were unavailable, crowding of patients increased, and guidelines for ventilation were unmet. While these design changes may be reversible, workarounds devised by users during this time offer actionable insights on how to create pandemic-resilient community clinics. Findings from the study can inform the development of guidelines for the design of flexible and resilient MCs which can effectively respond to contemporary and future public health emergencies.
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References
Agrawal T, Bhattacharya S, Lahariya C (2020) Pattern of use and determinants of return visits at community or Mohalla clinics of Delhi, India. Indian J Commun Med 45:77–82. https://doi.org/10.4103/ijcm.IJCM_254_19
Atkinson P (2007) Ethnography: principles in practice. Routledge, London
Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Seto WH, Li Y (2010) Natural ventilation for infection control in health-care settings (Illustrated). World Health Organization
Awbi HB (2003) Ventilation of buildings. Routledge
Capolongo S, Gola M, Brambilla A, Morganti A, Mosca EI, Barach P (2020) COVID-19 and healthcare facilities: a decalogue of design strategies for resilient hospitals. Acta Bio Medica: Atenei Parmensis 91:50–60. https://doi.org/10.23750/abm.v91i9-S.10117
Ciesielska M, Boström KW, Öhlander M (2018) Observation methods. Qual Methodol Org Stud 33–52. https://doi.org/10.1007/978-3-319-65442-3_2
Cranz G (2016) Ethnography for designers. Routledge, New York, NY
DDA (2016) Unified building bye laws for Delhi. https://dda.gov.in/building-laws. Accessed 12 Oct 2022
Delhi Govt. Health and Family Welfare (2022) http://health.delhigovt.nic.in/wps/wcm/connect/doit_health/Health/Home/Directorate+General+of+Health+Services/Aam+Aadmi+Mohalla+Clinics. Accessed 12 Oct 2022
Etheridge D, Sandberg M (1996) Building ventilation: theory and measurement. Wiley, Chichester
Khanna A, Srivastava A (2021) Role of Mohalla (community) clinics in providing primary healthcare: a study in Delhi. J Sci Res 65:29–33. https://doi.org/10.37398/jsr.2021.650405
Lahariya C (2017) Mohalla clinics of Delhi, India: could these become platform to strengthen primary healthcare? J Family Med Primary Care 6:1. https://doi.org/10.4103/jfmpc.jfmpc_29_17
Lahariya C (2020) Access, utilization, perceived quality, and satisfaction with health services at Mohalla (community) clinics of Delhi, India. J Family Med Primary Care 9:5872. https://doi.org/10.4103/jfmpc.jfmpc_1574_20
Sah T, Kaushik R, Bailwal N, Tep N (2019) Mohalla clinics in Delhi: a preliminary assessment of their functioning and coverage. Indian J Hum Dev 13:195–210. https://doi.org/10.1177/0973703019872023
Schroer J, Peavey E, Roark J, Holton S, Evans J (2021). The pandemic resilient hospital: how design can help facilities stay operational and safe
Sharma DC (2016) Delhi looks to expand community clinic initiative. The Lancet 388:2855. https://doi.org/10.1016/s0140-6736(16)32513-2
Vindrola-Padros C (2021) Rapid ethnographies: a practical guide. Cambridge University Press, Cambridge, United Kingdom
Wethington E, McDarby ML (2015) Interview methods (structured, semistructured, unstructured). Encycl Adulthood Aging 1–5. https://doi.org/10.1002/9781118521373.wbeaa318
WHO (2021) Roadmap to improve and ensure good indoor ventilation in the context of COVID-19
Zeisel J (2006) Inquiry by design: environment, behavior, neuroscience in architecture, interiors, landscape, and planning. Norton, New York, NY
Acknowledgements
The authors thank the following individuals from the Indian Institute of Technology Delhi for their important contributions: Mahuya Bandyopadhyay, Jay Dhariwal, P. V. Madhusudhan Rao, and Sabyasachi Paldas.
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Mohanty, A., Kar, G. (2023). Impact of Environmental Design Changes on Primary Healthcare Services in Mohalla Clinics During COVID-19: Findings from a Rapid Ethnographic Study. In: Hasan, A., Benimana, C., Ramsgaard Thomsen, M., Tamke, M. (eds) Design for Health. UIA 2023. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-031-36316-0_17
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