PHA-Exchange> Much health care in rural India comes from unqualified practitioners : BMJ

[SANJAY KUMAR]

http://bmj.bmjjournals.com/cgi/content/full/328/7446/975-b

Much health care in rural India comes from unqualified practitioners

New Delhi, Sanjay Kumar

Public and private healthcare facilities that purport to serve poor people 
in rural parts of India are increasingly catching the attention of 
researchers. A survey conducted by US researchers in Udaipur, Rajasthan, now 
provides hard data showing the nature of the availability of health care in 
rural India.

The researchers, Dr Abhijit Banerjee and Dr Esther Duflo from the 
Massachusetts Institute of Technology and Dr Angus Deaton from Princeton 
University, all working under the aegis of the institute’s Poverty Action 
Lab, found widespread symptoms of disease among the people surveyed.

Given the state of the public facilities, the main sources of health care 
are private practitioners and traditional faith healers (bhopas). However, 
such practitioners are largely untrained and unregulated, said Dr Banerjee. 
His team found that 41% of those in the private sector who called themselves 
doctors said they had no medical degree, 18% had no medical or paramedical 
training at all, and 17% had not even graduated from high school. In 68% of 
visits to private clinics or practices patients were given an injection and 
in 12% patients were given a drip, compared with 32% and 6% in public 
facilities. Only 4% of visits to private facilities led to a laboratory test 
for diagnosis.

The study also showed that on average 45% of medical or paramedical 
personnel were absent from government run sub-centres (serving a practice 
population of about 3600) and 36% were absent from the larger primary health 
centres (serving 48 000). The sub-centres were closed 56% of the time during 
their regular opening hours, at unpredictable times, discouraging people 
from walking an average of 1.4 miles from their village.

“The situation does not seem specific to Udaipur: these results are similar 
to absenteeism rates found in nationally representative surveys in India and 
Bangladesh,” the researchers said.

While patients should be getting free medicines at the public facilities, 
this was not always the case. Hence poor people rely less than the better 
off patients on the public facilities, say the researchers.

“These data paint a fairly bleak picture: villagers’ health is poor; the 
quality of public service is abysmal; private providers—unregulated and for 
the most part unqualified—provide the bulk of health care in the area,” say 
the researchers.

Responding to the results of the survey, Seva Mandir, a local 
non-governmental organisation working on rural and tribal developmental 
issues, is now implementing four new experimental interventions to address 
key healthcare problems.

“We will evaluate all of them, and, based on the findings, some or perhaps 
all of them will be expanded over the next few years,” Dr Banerjee said. To 
aid evaluation each intervention is being introduced in a random set of 
villages, as in a medical trial, he added.

Health Care Delivery in Rajasthan and papers on the interventions are 
available at www.povertyactionlab.com/papers


Rapid Responses:
Read all Rapid Responses

Medicine by non-medical people!
Vikas Dhikav
bmj.com, 23 Apr 2004 [Full text]
Doctors known by doctors?
John P Heptonstall
bmj.com, 24 Apr 2004 [Full text]
Westernized impression of health care systems in India: An agenda of neo 
imperialism!
Susheel Oommen John
bmj.com, 24 Apr 2004 [Full text]

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