Non-formal medicare in rural areas is rampant, says study

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, which covered 100 villages with 23,275 households in Madhya Pradesh between 2009 and 2011, was published recently in the journal Health Affairs .

“The average village in our sample could access 11 healthcare providers; 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 co-author Jishnu Das 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, added Das, who undertook the study with Aakash Mohpal.

The MP study represents a microcosm of healthcare delivery across the country, Das indicated. “From small-scale studies throughout India we find similar results,” he said. Das said the duo chose MP because they wanted to examine the rural areas of an economically backward northern State.

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

These “providers of average quality” were able to correctly diagnose five key conditions about 47 per cent of the time and correctly treat them 68 per cent of the time. “

The study pointed out that “providers with an MBBS degree had higher correct diagnosis and correct treatment rates, relative to those with alternate qualifications and those without any medical training.”

Against this backdrop, the study suggested a couple of options worth following for the government: training informal sector providers; and providing medical transport that allows households from scattered villages to visit providers in larger towns.

Providing public care in scattered rural outposts is a very costly option, the study said.

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,” it said, making a case to train informal workers.

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.

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