Primary Health Care Diagnosing Doctors

DELHI AND KIGALI  In poorcountries it is easier than ever to see a medic. But it is still hard to find one who will make you better

AT THE Peeragarhi clinic in west Delhi, a woman takes a fold of her gold sari and wipes her brow. She is the 140th patient of the day and Dr Alka Choudhary shows no sign of flagging. The doctor poses questions (“Have you been sick?”; “Do you ache?”), gauges the patient’s blood pressure and checks for rashes. The illness may be dengue fever, a viral infection common in the surrounding slum. She takes a blood sample, prescribes oral rehydration tablets and tells the woman to return soon.

Before the mohalla (community) clinic opened in 2015, many of Dr Choudhary’s patients would have queued all day at a hospital or gone untreated. Now, like thousands who attend the 158 such clinics that have opened over the past two years in Delhi, they receive free, comprehensive medical care, all under one pre fab roof.

According to the World Bank, primary care—the generalist, front-line form of medicine practised by Dr Choudhary—can deal with 90% of health problems. A survey of 102 developing countries in 2015 found that those with established primary-care systems had higher life expectancy and lower infant mortality. Recent rollouts of primary care, for example in Brazil, Rwanda, Sri Lanka and Thailand, have been followed by falls in child mortality.

In 2015 governments across the world pledged to expand primary care as part of the UN’s “sustainable development goals” to be met by 2030. A similar aspiration was expressed in 1978, but little was done. The renewed ambition reflects a recent change in approach to health care in developing countries.