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

[sonali jain]

BMJ 24 April, 2004
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





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