Study makes case to train non-formal medicare providers

The first port of call for medical treatment in an average village in the country seems to be from providers without any formal medical training, suggests a recent study done by two economists from the World Bank.

The study undertaken in Madhya Pradesh covering 100 villages, 23,275 households and data collected between 2009 and 2011 was published recently in the Health Affairs journal.

“The average village in our sample could access 11 healthcare providers and 49 per cent of these providers had no formal medical training. Usage data are even more striking: 77 per cent of all primary care visits were to providers without any formal medical training. Only 11 per cent of all primary care visits were to the public sector and only 4 per cent were to providers with an MBBS degree,” the study noted.

The study stops short of calling the non-formal medicare providers quacks, and Jishnu Das, one of the authors of the study explains why. “We don’t call them that because the word implies that they have no medical knowledge, whereas the quality of the care they provide is comparable to the public sector,” Das told BusinessLine . Nevertheless, they had no formal medical training, he added. Das along with Aakash Mohpal undertook the study.

In fact, the MP study did represent a microcosm of healthcare delivery across the country, Das indicated. “From small scale studies throughout India we find similar results,” he added.

MP was chosen because they wanted to examine rural areas of a poorer northern state, Das said and “MP is one of the states with high infant and child mortality, and its health outcomes are among the poorest in India. In addition, MP had tried various innovative programmes to try and improve the public sector, including the Rogi Kalyan Samiti.”

Diagnosis and prescription

Following up on the findings, the authors suggest training these informal medicare providers to be able to support the larger system.

These “providers of average quality” were able to correctly diagnose five key conditions about 47 per cent of the times and correctly treat them 68 per cent of the time. “Because in some cases correct treatment could include “referrals to a higher level”, conditions could be correctly treated without a correct diagnosis,” the study says.

Not taking away from the benefits of trained professionals, the study points out that “providers with an MBBS degree had higher correct diagnosis and correct treatment rates, relative to those with alternate qualifications (AYUSH) and those without any medical training.”

Against this backdrop, the study suggests a couple of options worth following for the Government: “training informal sector providers who practice in every village, and (b) providing some kind of medical transport that allows households from rural and scattered villages to visit providers in larger towns and cities.”

Providing public care in scattered rural outposts is a costly option, the study says and “Even if the government were to staff these posts, the number of patients would be so low that doctors may effectively provide care to only five-six patients a day.”

Blend into this, the study’s findings that the vast majority of households surveyed over two years relied on private sector providers without formal medical training for their primary care needs. This was the ground reality, despite the significant increases made in budgetary allocations through the National Rural Health Mission, it points out.

This study was funded by the Global Health Program of the Bill & Melinda Gates Foundation and The Knowledge for Change Program at The World Bank.

jyothi.datta@thehindu.co.in

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