Rohit Kumar Singh, Additional Chief Secretary, Medical, Health & Family Welfare, Government of Rajasthan

Since the announcement by the Chief Minister Ashok Gehlot in the first budget of the new government, Rajasthan is briskly moving ahead with its plan to establish Janta Clinics across the State. The objective is to cater the urban population with IT-enabled high quality primary healthcare services. Kartik Sharma of Elets News Network (ENN) talks with Rohit Kumar Singh, Additional Chief Secretary, Medical, Health & Family Welfare, Government of Rajasthan on how Janta Clinics will achieve its target of health for all in the state of Rajasthan.

Q WHAT IS THE GENESIS OF THE IDEA OF JANTA CLINIC FOR THE URBAN POPULATION OF THE STATE.

We realised that especially in urban areas there is an undue load at the tertiary healthcare facilities for people who have only primary care problems. We studied the issue and understood that the out of pocket expenditure of the urban poor on health was the highest in any category, something which we felt was very counterintuitive. That is why we came up with the idea to cater to this demographic with Janta Clinics. We also felt that the clinics should have excellent hygienic conditions and the best available technology.

Q PLEASE GIVE US MORE INSIGHTS ON THE CONCEPT OF JANTA CLINICS. HOW WILL IT HELP THE PRIMARY HEALTH AND DIGITAL HEALTH ECOSYSTEM IN THE STATE?

The Government of Rajasthan has a vision with the commitment to reach out to every deprived and vulnerable household of urban area with special focus on provision of IT-enabled high quality primary healthcare services under the title of “Janta Clinic”. Therefore, the Honourable Chief Minister of Rajasthan, Shri Ashok Gehlot, announced the launch of “Janta Clinics” in the Rajasthan State Budget Speech, July 10, 2019. The Department of Medical, Health & Family Welfare, Govt. of Rajasthan has introduced Janta Clinics to provide high-quality primary healthcare services along with provisions of free drugs, free diagnostics and consultation/ treatment facilities with use of technology and innovations. These clinics are meant to provide primary healthcare with provisions of drugs, diagnostics and treatment along with systematic referral linkages to secondary and tertiary care health facilities. Janta Clinic is a step towards ensuring universal health care to achieve health for all in the state of Rajasthan.

Q HOW MANY JANTA CLINICS HAVE BEEN BUILT TILL DATE AND WHAT ARE THE PLANS TO BUILD MORE IN NEAR FUTURE?

At present the 5 Janta Clinics are operational at at Jaipur. Other seven clinics are scheduled to be inaugurated soon. We are hoping that all twelve clinics will be functional by the end of February. Areas for three other clinics have also been identified in Jodhpur. The Janta Clinics function at buildings which are donated or made under corporate social responsibility. Each Janta Clinic is aimed at catering to a population of more than twenty thousand in urban areas with facilities such as vaccination, primary healthcare, free primary diagnosis tests and medicines. Ever since the clinic in Valmiki Colony was inaugurated in December by Chief Minister Gehlot, it has seen a steady flow of patients every day. We are seeing a patient flow of at least more than 750 persons every day at the 5 operational clinics. In general, the patients who come have cases of seasonal diseases, respiratory problems, joint pains, diabetes and skin diseases. Most of the patients are from the economically backward background.

Q WHAT ARE THE MAJOR OBJECTIVES BEHIND THIS SCHEME?

The basic goal of the scheme is to improve health status of underserved & vulnerable population of the state by providing high-quality IT-enabled primary healthcare services through Janta Clinic. Through Janta Clinics we will be creating longitudinal medical history (Electronic Health Record) of all beneficiaries.

Q HOW ARE YOU PLANNING TO TAKE THIS CONCEPT OF ‘JANTA CLINIC’ AHEAD?

The State of Rajasthan is develoing IT-enabled Janta clinics to provide quality primary health care services in difficult to reach areas to cater more than twenty thousand population. Implementation will take place through shared responsibilities of the Department of Health and Family Welfare and supporting partners.

The Department of Medical, Health & Family Welfare, Govt. of Rajasthan envisions end-to-end IT enabled paperless Janta Clinics which will transform the way primary healthcare is tracked and delivered. The mobile application guides structured data collection, eases the retrieval of medical history, provides clinical decision support to the providers, and ensures the beneficiary was physically seen by the provider through offline biometric verification. In this way, the Janta Clinic project will ensure high quality, actionable, accountable data for effective healthcare delivery.

Implementation strategy for this scheme will be based on several aspects, likewise, Operationalization, Population Coverage, Location, Identification of Building, Infrastructure and Human Resource. Each clinic will cater to a population of more than 20,000 people in the neighboring community. Janta clinic will be established in urban underserved (slum/dense) areas. Each clinic will be linked to nearby PHC/UPHC. Janta clinics will be operational in Government building or donated building which will be finalized after due approval of state authorities. Janta clinic will have sufficient space for registration, waiting area, doctor services, nursing services, sample collection area, pharmacy and basic amenities(Male & female toilet, drinking water area, etc.) Each clinic will be branded as per standard branding guidelines of Janta Clinic. Human Resource: Each Janta clinic will have qualified staff to provide healthcare services as per framework. Staff will report to concerned CMHO for all administrative and clinical purposes.

Q WHAT ALL SERVICES WILL BE PROVIDED AT THE JANTA CLINIC?

Janta clinic will provide institutionalized outdoor services as consultation, basic RCH services, NCD screening, laboratory diagnosis & drugs as per state scheme, contraceptive dispensing along with distribution of health education material, counseling for preventative healthcare and referral services.

Medical officers will provide consultation for primary healthcare. A total of 7 hours of OPD services out of which 4 hours in the morning and 3 hours in the afternoon for six days in a week and 2 hours in the morning on Sunday and Holidays.

There will be availability of free investigations as per state scheme (MNJY). Lab tests wil be available as per Mukhyamantri Nishulk Janch Yojna (MNJY). Currently total 7 card test is being provided at Janta Clinic till the arrangements of all lab tests.

Free drugs & consumables will be provided at Janta Clinic as per norms of MNDY scheme applicable at primary healthcare level facility. A Separate E- Aushdhi account will be operated for each Janta Clinic. Drugs will be supplied from linked PHC/UPHC to Sub-store of Janta Clinic based on indent raised by Janta Clinic Sub-store. Sub-store will issue drugs to DDC of Janta Clinic from where drugs will be dispensed to patients as per prescription.

The clinics will provide RCH and Adolescent Health services. The clinics will provide Counseling services related to sexual concerns, pregnancy, contraception, abortion, menstrual problems etc. Nutritional Counseling, Prevention and management of nutritional anemia, STI/RTI management, Management of anaemia through WIFS program.

Q WHAT ARE THE FACILITIES AVAILABLE FOR CHILD AND MATERNAL HEALTH AT THE JANTA CLINIC?

In case of maternal health services, Ante Natal Care will be provided at the clinics. Early registration of all pregnancies ideally in the first trimester (before 12th week of pregnancy). However, even if a woman comes late in her pregnancy for registration she should be registered and care given to her according to gestational age. There will be Minimum 4 antenatal checkups and provision of complete package of services. Provision of associated services and micro nutrients will be there like Iron and Folic acid (IFA) tablets, Calcium supplementation, Albendazole tab for de-worming, Injection of DiphtheriaTetanus(DT) Toxoid. Minimum laboratory investigations like Hemoglobin, Urine albumin and sugar, RPR test for syphilis, HIV test. Janta Clinics will provide Nutrition and Health Counseling including advice on balanced diet and counseling for tobacco cessation if the antenatal mother is a smoker or tobacco user and information about dangers of second hand smoke. There will be Identification and management of high risk pregnancy and alarming signs and timely referral of such identified cases to the nearby health facility which are beyond the capacity of Medical Officer to manage.

We will focus on Full Immunization of all infants and children against vaccine preventable diseases as per guidelines of GOI Vaccination like Vaccination to Pregnant Women and Vitamin A prophylaxis to the children as per national guidelines.

In case of Child Health Services we are providing Nutrition and management of general childhood illness. Screening of all children in the age group of 6 to 59 months by MUAC tape and if the weight for height of the children is less then Z-score, will be measured to check the malnutrition level. All SAM children will be referred to MTC. The clinics will ensure timely referral in case of emergency, after initiation of basic treatment as per available services at the facility. Here we will focus on Counseling of all parents on Infant Young Child Feeding along with counseling on balanced diet. We will stress on Prevention and control of routine childhood diseases, infections like diarrhoea, pneumonia etc. and anemia etc. There will be timely referral in case of emergency, after initiation of basic treatment as per available services at the facility. Clinics will ensure Screening of beneficiaries having low level of HB (hemoglobin), Diagnosis and management of anaemia and vitamin A deficiency.

Q WILL THERE BE ANY PROVISIONS AT JANTA CLINCS FOR FAMILY WELFARE SERVICES AND SCREENING OF NON COMMUNICABLE DISEASES (NCD) THAT ARE QUITE PREVALENT IN FAMILIES.

We are providing family welfare services at Janta Clincs which includes Education, Motivation and Counseling to adopt appropriate Family planning methods, provision of contraceptives such as condoms, oral pills, emergency contraceptives and referral and Follow up services to the eligible couples adopting permanent methods like Tubectomy/ Vasectomy, Counseling and appropriate referral for couples having infertility.

We are also focusing on NCD screening including Hypertension diabetes and Cancer Screening and registry (Oral Cancer Screening, Breast Cancer Screening, Cervical Cancer Screening)(through specialist visit on a fixed day in a month). In case of secondary or tertiary care, patient will be referred to nearby higher level facility.

Q FOR THE FIRST TIME IN RAJASTHAN, THE SYSTEM OF DIGITAL PRESCRIPTION HAS BEEN STARTED AT THE JANTA CLINIC. PLEASE TELL US ABOUT THAT.

Under the digital prescription system, the details and case history of a patient is entered in the mobile as he/she enters the clinic and this is later sent to a tablet, which has been given to the doctor. After checking the patient, the doctor writes the prescription digitally on the tablet which is then sent to another mobile kept with the pharmacist. After the free medicine is provided to the patients, they are given a printout with details of their diagnosis and medicines.

Q JANTA CLINIC IS A TOTALLY IT ENABLED SYSTEM. PLEASE EXPLAIN ABOUT THE IT INTERVENTIONS AT ALL THE LEVELS IN A JANTA CLINIC.

Janta Clinic is a great example of digital health. We follow IT enabled clinical workflow at Janta Clinic. Once patient will enter the clinic registration will be done at registration desk through smart phone. After registration, patient will enter in queue. In case of emergency, patient will be attended by nursing station directly.

After registration patient will approach to nursing station as per his/her turn shown in queue management system for recording of complaints, history and for vitals examination. Staff nurse will record all data in smart phone.

After nursing station, patient will approach to doctor’s cabin as per his/her turn shown in queue management system where doctor will do consultation and prescribe medicines or lab test. Doctor will record data in Tablet.

In case of ANC, Immunization and sample collection/card tests, patients will approach to nursing station II where ANM will provide ANC services & immunization services along with blood/urine sample collection for lab tests as prescribed by the doctor. NCD screening will also be done by ANM at nursing station II. ANM will record all required data in smart phone. Afterwards, patient will approach Doctor’s cabin again for treatment/ consultation and prescription of medicine.

At last, patient will approach to the pharmacy and will exit the clinic after receiving medicines and printed prescription. Pharmacist will record all required data in smart phone.

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