Untrained or trained, errors mark rural healthcare


Rural India has several times as many unqualified healthcare providers as those with a medical degree, a new study has found. Such unqualified providers account for 70 of every 100 primary care visits in a rural setting, says the study on the quality of care delivered by private and public providers of primary health care services in rural and urban India, and published in the December edition of Health Affairs.

The study found that qualifications of healthcare providers do matter, but perhaps not as much as expected. Diagnosis and treatment were often incorrect irrespective of qualifications.

"In both the rural and the urban settings, we found only small differences between trained and untrained doctors in adherence to the clinical checklist, and no differences in the likelihood of providers giving a diagnosis or providing the correct treatment," said Jishnu Das, a visiting fellow at the Centre of Policy Research and a senior economist at the World Bank.

"Nor did we find better care in public relative to private clinics. In fact, the evidence suggests that untrained private-sector providers were better in adhering to the checklist, and no worse in their treatment protocols, than their public-sector counterparts."

Das, along with researchers Alaka Holla Veena Das, Manoj Mohanan Diana Tabak and Brian Chan, undertook the study at sites in Madhya Pradesh and New Delhi. The study was funded by the Global Health Program of the Bill and Melinda Gates Foundation.

In rural Madhya Pradesh, 67 per cent of the sampled healthcare providers had no medical qualifications at all, 22 per cent had some training in traditional medicine, and only 11 per cent had a medical degree. And whether the workers were qualified or not, the study found, correct diagnosis was rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics.

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