According to India’s first comprehensive assessment of public and private health care availability and quality, at least two of every three “doctors” in rural India are informal providers of care, with no proper qualifications in the modern system of medicine.

In a survey done in 2009 by researchers from the Centre for Policy Research (CPR) in New Delhi of 1,519 villages across 19 states, found that 75% of villages have at least one health care provider and in a village, generally there are three primary health providers. In them, 86% are private doctors and 68% have no formal medical training. This survey was published in the Social Science and Medicine journal.

The study also supports the 2016 report on ‘The Health Workforce in India’ by the World Health Organization. It reported that 57.3% people who are practicing allopathic medicine in India didn’t have a medical qualification, and only 31.4% were educated up to secondary school level.

The CPR study found that proper qualifications were not a predictor of quality, through the medical knowledge of informal providers in Tamil Nadu and Karnataka which is higher than trained doctors in Bihar and Uttar Pradesh.

Lead author Jishnu Das, professor at the McCourt School of Public Policy said in an email that for the huge majority of rural households, informal providers, also called quacks are the only option that is available locally. Public health clinics and MBBS doctors are very few and placed far hence they are not an option for many villagers. He said he had worked in Madhya Pradesh and West Bengal and knew the situation but later realized that this generalized in every state, except Kerala. Therefore, the awareness in health policy should be that as the states get richer, informal providers will be automatically wiped out. Jishnu Das is also a professor at the Walsh School of Foreign Service at Georgetown University in Washington.

The number of informal providers has not declined with growing socioeconomic status, however the quality of doctors has improved. The study has found no connection between the average local availability of healthcare providers and indicators of state health, for example child mortality, that indicates although people in villages can select among multiple providers but they still do not get any quality health care.

The study found that the huge variation in medical knowledge was diligently tied to training. Das said that the difference across states in the quality of an MBBS degree is vast, as southern states are doing much better than states in the north. As the informal providers usually spend a few years with a formal doctor, as a compounder or as some attendant, their knowledge depends also on who they had worked with. Thus, the quality of informal providers and MBBS doctors moves ahead together.

The paper projected informal providers accounted for 68% of the total provider population in rural India, out of which 24% being Ayush doctors practicing traditional and alternative branches of medicine and only 8% were having an MBBS degree.

Yamini Aiyar, president and chief Executive, CPR, said that the COVID-19 pandemic has put exceptional demands on health care to have an urgent discussion on how things should be structured for moving forward. This important paper reveals the fundamental features of rural health care systems with significant insights for regulation, training and capacity.

India is divided into two nations by quality of health care providers and by costs, with better performing states providing higher quality at lower per-visit costs. This trend was constant with substantial variation in the availability and quality of medical education through the state. According to professor Das, nothing has much changed since 2009. The cost of private healthcare has only certainly changed.

“Training community health officers to provide free primary health care with tele-medicine support at health & wellness centres under Ayushman Bharat is a way out, but for similar training of informal providers in the private sector to work, we need safeguards to ensure they don’t further misuse the training and put the health and lives of patients at risk,” said

Dr Randeep Guleria, director, All India Institute of Medical Sciences, Delhi, said that training the community health officers for offering free primary health care with tele-medicine support at health & wellness centres under Ayushman Bharat is a one way out, but for similar training of informal providers in the private sector, they need to safeguards not to have further misuse of the training and place the health and lives of patients at risk.

Source: Hindustan Times