**5. Role of Mobile clinic programs in healthcare disparities**

The COVID-19 pandemic has exacerbated existing limitations of our health systems when confronted with the unexpected emergence of major diseases and highlighted the prevailing disparities in the healthcare delivery system. Populations affected in such situations tend to be the poor [18]. Mobile healthcare delivery programs play an important role in effectively supporting under-resourced populations during pandemics, and do so in a cost-effective manner [1]. Harvard Medical School's Family Van is an excellent example, offering blood pressure screenings, and other chronic disease management services [19]. These screenings decrease the risk of heart disease and stroke, and other chronic conditions which if left untreated can result in negative health outcomes and further increase health disparities.

Mobile clinics are adaptive and have the capability to help address emergencies in both an innovative and timely fashion [20]. As long-standing community-based healthcare delivery avenues, they play a critical role in addressing healthcare access barriers that exacerbate healthcare disparities. For example, representatives from a clinic in North Carolina highlighted challenges around equitable access to healthcare that the population of farmworkers they serve, face. "The idea of having those responsible for meeting the economic need of providing food for individuals in the nation, have difficulty with accessing healthcare, is unimaginable". The ways in which the mobile clinic has proven resourceful to the farmworkers is by providing healthcare at minimal costs, and partnering with stationary clinics to ensure a continuum of care [10].

### **6. Decision tool for Mobile clinics deployment**

Results from the survey conducted by Attipoe-Dorcoo et al. [10], also indicated that counties in North Carolina and Florida experienced varying degrees of additive effects from the provision of primary and preventive care via mobile clinic providers. Mobile clinics in these counties were influential in delivering critical primary and preventive healthcare services to under-resourced populations. A mobile clinic primary care service index was constructed taking into account miles traveled by the mobile clinic, speed of the mobile clinic, number of primary care providers per mobile clinic program, number of primary care providers available in a primary

care service area (PCSA), and the total population in a PCSA [21]. The index provides a valuable unit of measure to enable program managers of primary care mobile clinics to allocate their resources accordingly based on either a goal to extend their level of influence, which can be a metric to share with funders, or identify other potential areas of need to establish influence. Geographic areas with the greatest need can be identified via the lowest index, and resources can be allocated either as additional providers or mobile clinics to ensure the health needs of populations are met [21].

The findings from Attipoe-Dorcoo et al. [10] also highlighted that only one mobile clinic organization was identified in three counties in North Carolina and a similar situation was observed for rural counties in Florida as well. Anecdotally mobile clinic representatives constantly advocate for more mobile clinic access in rural areas, however, the challenges of implementing such efforts are yet to be overcome nationally. The index could be a tool that is leveraged to help provide the needed geographic metric needed in operational decision-making to ensure efficient allocation of resources [21].
