The clinic at the market

A district health service wanted more adults screened for high blood pressure. The clinic was free, well staffed and almost empty.

The assumption was that people did not understand why screening mattered, so the service ran an information campaign. Attendance did not move. A second theory was cost, but the service was already free.

Somebody then spent two days asking people at the market why they had not come. The answers were almost entirely about time and place. The clinic opened from eight to four, which is exactly when people with the least secure work cannot leave it. It was a twenty-minute walk from the market. And it looked like a clinic, which meant that being seen entering it invited questions from neighbours about what was wrong.

The service responded by taking a table to the market on Wednesday mornings, next to the vegetable sellers, with no private room and no appointment. Screening numbers rose by a factor of six in two months. Nothing about the medical content changed and no further information was distributed.

The pattern is one of the most repeated findings in public health. When a free service is not used, the explanation is rarely that people do not want it. It is usually friction — distance, hours, paperwork, visibility — and friction is invisible to whoever designed the service, because they experience none of it.