Delivering prevention where people are: Mobile health clinics as a case study
By: Arunima Himawan
“Most of prevention can and should be carried out outside hospitals, and primary care has a very important role to play here. Prevention should be delivered in places such as in community centres or in the workplace, with the support of the primary care system” – Michele Cecchini, Head of Public Health, Employment, Labour and Social Affairs, Health Division, OECD
Cultural, economic and geographic divides within societies have led to deep-running inequalities in access to healthcare and have exacerbated inequalities in health outcomes, as has been devastatingly exposed during the ongoing COVID-19 pandemic.
The pandemic has demonstrated that technology has the power to connect under-served populations to vital health services. That said, as we come out of the pandemic, there is a risk that technology will be perceived as a magic bullet in democratising access to preventative health, when we know that we must also ensure we are actively engaging communities by offering prevention where people are. One example of a health intervention successfully offering prevention to the under-served community and promoting better health outcomes, whilst also reducing the economic burden placed on healthcare systems, is mobile health clinics (MHCs).
MHCs are vehicles, often vans, that deploy a range of tailored health services in known community areas, with the aim to reach targeted populations who are traditionally at higher risk of ill-health and/or have little contact with the wider healthcare system.
In the US, there are currently 2000 operating MHCs serving 7 million people annually. In India, HelpAge’s Mobile Healthcare programme, Asia’s largest mobile healthcare network for older adults, operates 174 MHCs serving more than 2586 community locations and provides 2.5 million treatments annually. These clinics can easily penetrate high-risk communities (helping many avoid long hospital waiting times, or minimising costs to access services) and, in particular, offer tailored services to those in deprived areas and rural communities, as well as minority groups and those with multiple risk factors for disease. In both countries, MHCs offer screenings and vaccinations, manage chronic diseases such as hypertension, asthma, cancer and heart problems.
Crucially, in India these clinics offer access to free health check-ups and free medication on a regular basis, including home visits, and keep patient records to monitor individual progress. Between 2010-2012, one US MHC offering hypertension management services reported that 5,900 patients who presented with high blood pressure during their initial visit exhibited reductions in blood pressure at their follow-up visits. These reductions translated into 32.3% lower relative risk of myocardial infarction and 44.6% lower relative risk of stroke for the patient.
Because MHCs operate in the hearts of communities, they play a crucial role in getting people to engage more frequently with the healthcare system. For example, another US MHC found that 56% of patients reported their MHC visit to be their first encounter and connection with the healthcare system. MHCs also often operate in familiar locations like shopping centre car parks and make access to healthcare much more convenient, addressing barriers such as distance to health services, and long hospital wait times.
Moreover, they appear less intimidating to those who distrust the wider healthcare system. By building trusted relationships with their patients (enhanced by people’s perception that the clinics are reaching out to care for them), MHCs inspire patients to take greater control of their health. For example, they are able to educate them on how to prevent disease, manage chronic conditions, and improve adherence to medications. New Mexico’s HABITATS for Life mobile screening programme found that 78% of its screening participants engaged in healthier behaviour as a result of participating in the programme. In India and the US, MHCs have also acted as an important link between individuals and the wider healthcare system, providing access to wider social services and outreach programmes, government schemes and additional preventative health awareness programmes.
Despite MHCs being introduced as early as the 1960s in the US and the 1970s in India, and similar services offered across many countries, they are often unrecognised as a vital healthcare service and continue to be severely under-utilised. Indeed, during the coronavirus pandemic, MHCs could have played a vital role in getting testing to at-risk and unreachable communities, including rural areas.
If governments are serious about addressing inequalities in health, they need to invest in their prevention and public health infrastructure by supporting expansion and better integration of cost-effective interventions such as MHCs into the wider healthcare system. The coronavirus pandemic has shown first-hand the cost of not investing. Inaction is not an option and MHCs offer a great opportunity demonstrate commitment to the prevention agenda.
Find out on how we can deliver preventative health interventions on our “Delivering prevention in an ageing world” programme page.
Research Fellow, ILC
Arun joined the ILC in March 2019 as a Research Fellow.
Arun has mainly worked in the charity sector, most recently within higher education at Goldsmiths College and University of East Anglia’s Students’ Unions in policy and research roles working to improve the barriers facing marginalised students. In both roles, she has acted as a policy advisor, influencing internal university policy and has produced a number of in-depth pieces of research on a wide range of topics such as: religion and belief; mental health; and consumer law. Prior to her work at students’ unions, Arun was a Charity Works graduate and also worked for the Commonwealth Human Rights Initiative in administrative and project roles working on freedom of information and prison reform. Her research interests are in addressing social determinants of health, particularly on the topics of overweight and obesity, mental health, and inter-generational trauma.
Arun has an MSc from King’s College in Global Health, an MA from the School of Advanced Study in Human Rights, and a BA (hons) from the University of Toronto in Sociology and Ethics.