Background: Over two-thirds of the Uttaranchal State has a difficult geographic terrain and is characterized by scattered and sparsely populated districts. The efficacy of the traditional 'fixed-location' healthcare facilities is severely limited by inaccessibility due to adverse topographical conditions. To make services available to the community mobile health clinics were started in the State. Activities: Mobile Health Clinic was initiated to supplement the existing public health facilities. It follows a 'fixed day, fixed time and fixed place' approach to provide health care service in remote, hard-to-reach and poorly served hilly areas in the State.Mobile van named ‘Sehat ki Sawari’ was started since 17thNovember 2004 in Chamoli District under Garwal division with the help of Standing Committee on Voluntary Action (SCOVA). It serves on twelve fixed points covering five to seven villages en route. Mobile clinic has fixes route plan and covers each point twice a month.Second mobile clinic called Technology for Information forecasting Assessment Counselling (TIFAC) was started in Kumaon division with the help of Birla institute, Bhimtal and run by State and Government of India (GoI). The clinic also provides diagnostic facilities along with curative health care and health awareness programmes in 6 districts (Champawat, Nainital, Almora, Bageshwar, Pithoragarh and Chamoli) covered under TIFAC project. Monthly visit is given at each served area. Results:Up to January 2005, under Sehat Ki Sawari:1177 OPD cases seen, 58 Family Planning cases and 63 counselling sessions held. Under TIFAC clinic: Patient attended were- 37,665 OPD patients, 8,305 ultrasounds, 4,729 X-rays, 1,476 ECG, 16,792 lab tests.

Coverage of difficult area: Mobile vans help to cover all those areas that are inaccessible topographically. Basic services availability: Minimum basic primary health care services are made accessible to the community living in difficult area.

Inaccessible area: Due to geographical constraints even some area are very difficult to access. Therefore needs intensive IEC to reach on scheduled time. Logistic: drugs and other recurring logistics do pose problems in the smooth functioning. Staff constraints: Professional staff to replace the duty of the posted staff is difficult to get in case whenever it is needed.

Government order

State government

It is dependent on government commitment and funding

Good, especially in difficult hilly areas and limited human resources to deliver services.

With resource constraints, both financial and human, to deliver services in the uncovered areas mobile clinic is the alternative for optimum utilisation of the available resources

Dr. Anuradha Davey, Research Consultant, NIMS, February, 2006.