Why mobile clinics are a hope in despair during disasters, health emergencies

By Jayanti Saha, Sanghmitra Acharya*
In 1978, the Declaration of Alma-Ata stated that access to primary healthcare is the right of all the population and to achieve the goal of health for all. Primary healthcare integrates prevention, promotion, and education to meet the health needs of all patients in the community. But still, in the 21st century, a substantial proportion of populations
are deprived of access to primary healthcare services across the world.
Therefore, to provide primary healthcare services to underserved population, the Mobile Health Clinic (MHC) become a popular model developed over the period. MHC is a customized vehicle reaching the doors of the vulnerable communities living not only in the rural areas but also in the urban slums.
In fact, it is found to be the authentic strategy to provide health services to the people displaced due to wars, political upheaval, and in different emergencies like disasters where no other alternative healthcare is available to the people.
There are various types of MHCs such as mobile vans, camels, boats, and helicopters to serve the hard-to-reach population in hilly areas, deserts, and islands. For instance, in the Loreto region due to the presence of the river Amazon and its tributaries, the health services are delivered through a customized boat to the communities living in the interior parts. Similar evidences are observed in the southern part of Myanmar, Congo, Burundi and Western Tanzania, the char in Bangladesh and India through which health services are provided.
Camel clinics are used in the desert in Kenya because their large footpads make it easier to navigate on stony and sandy roads. Likewise, the primary healthcare services are provided through mobile vans in Rajasthan to the tribal people residing in the inaccessible desert villages.
Helicopter is one of the vehicles which are used rarely to serve the hard-to-reach underserved tribal population in undulating hill areas, and forest-covered villages of Tripura in India where people have no healthcare facilities.
Though MHC cannot meet static health centres in terms of consistency of care and variety of services, it can offer essential health services with adequate efficacy in settings where permanent health centres are not available.
Generally, MHCs are used to deliver primary care, preventive health screenings, chronic disease management, dental care, immunization, antenatal, postnatal care, reproductive healthcare, mental healthcare, awareness campaign on hygiene and other health-related issues.
MHCs facilitate healthcare services, particularly to the geographically isolated, socially deprived, and vulnerable population. By removing transport, financial and cultural barriers it reduces access-related barriers to the mainstream healthcare provision of the community, and it is considered as linguistically and culturally appropriate care.
Thus, besides the general population the MHCs emphasize targeting low-income, minority groups, tribal population, children, pregnant women, adolescent girls, displaced population, elderly people, homeless people, migrant workers, LGBTQIAP+, etc.
The MHCs are funded by international organisations, governments and non-profit organizations. But majorly philanthropy is the primary source of funding for MHCs. NGOs across the globe play a vital role to acquire funds and provide services through MHCs to remote locations.
As a part of corporate social response, MHCs are launched across the underserved areas of the country. Before the National Rural Health Mission (NRHM) the MHCs operated by the state in tribal districts. But after the launch of NRHM, it has expanded its opportunity to avail funds for MHCs to "take healthcare to doorsteps of the public in rural areas, especially in the underserved tribal areas.
Along with provision of primary healthcare MHCs plays a very important role during disasters and health emergencies. Disasters have a significant impact on healthcare facilities, making it difficult for patients to get timely and adequate medical care. In such a situation, MHC is an alternative for providing medical care for disaster victims who find it difficult to go to medical facilities due to logistical constraints.
In Assam, boat clinic reach to render healthcare services in the flood-hit inaccessible riverine islands. Similarly, the WHO deployed medical emergency Mobile Medical team during the massive flood in South Sudan to provide healthcare to the affected populations with special attention to children and women.
In recent times the uses of MHCs become more pervasive during the Covid-19 pandemic because the pandemic has substantial impact on health system. Due to the travel restrictions, suspension of transportation facilities and fear of coming in contact with the virus of Covid-19 there is a huge decline in in-person preventive care and regular healthcare visits in the health facilities.
To address the health needs of the population and reduce barriers MHCs provided door-to-door healthcare services. In many slums of India, MHCs are used to screen patients having common illnesses such as cough, colds, and body aches. It is deployed with doctors in the high-risk zone areas wherever the numbers of positive cases are on the rise to immediately identify, isolate potential spreaders and treat the people who test positive.
Delivering healthcare services through MHCs is not a new phenomenon. After a disaster when fixed healthcare delivery is disrupted the MHCs are deployed to reach those people without access to healthcare. During the disaster and pandemics, it helps to understand how MHCs can fill gaps of permanent healthcare facilities at the time of crisis and emergencies.
There is thus a pressing need to be more prepared to handle any future public health emergencies by expanding the use of the MHCs and its services through integration in healthcare delivery system as it has the potential to address the primary healthcare needs of the population at the time of public health emergencies.
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*Jayanti Saha is a PhD scholar, Sanghmitra Sheel Acharya is professor at the Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi