The compulsion to improve the level of competence of private health-care providers with no formal training in rural areas has once again been highlighted by a survey of over 23,000 households in 100 villages in Madhya Pradesh
On average, people had access to 11 health-care providers in a village. Seventy-one per cent of these providers were in the private sector but only 51 per cent had any formal medical training. In terms of primary care visits, the private sector accounted for 89 per cent, of which 77 per cent visits were to the providers who had no formal training. In contrast, only 11 per cent of all primary care visits were to the public health sector and only 4 per cent were to providers with an MBBS degree.
Despite the fact that availability of primary care centre in the public sector and the competence of doctors in the public sector improved with village size and socioeconomic status of households in a village, doctors in the public sector spent only 2.1 hours a day seeing patients as there were fewer patients per provider. This is despite the fact that doctors with formal training were relatively more competent as they exhibited higher correct diagnosis and correct treatment rates than health-care providers who were trained in alternative medicine and those without any training whatsoever.
The results of a study were published on October 5 in the journal Health Affairs.
Only 30 villages had a doctor with an MBBS degree (private or public sector) and only 31 villages had access to a public primary care centre. In contrast, quacks were present in all but one village. Eighty-eight of the hundred villages had access to at least three quacks.
The study found that the socioeconomic status of a village and not household determines the quality of care that people receive. Households with low socioeconomic status located in villages with high socioeconomic status were able to access more competent health care providers. But households with low socioeconomic status located in villages with low socioeconomic status access low quality care. “Poor people living in poor communities are especially deprived of high-quality health services,” the authors write.
“Providing public care in scattered rural outposts is a very costly option. 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,” says Jishnu Das, a senior visiting fellow at the Centre for Policy Research, New Delhi and the first author of the paper. Imparting training to improve the competence of providers in the informal sector and providing villagers transport to seek care from health care providers located in larger towns are viable alternatives, the authors say.