Are India’s quacks the answer to its shortage of doctors?

Priyanka Pulla asks this interesting question. India has a huge shortage of doctors and quacks proliferate wherever they can. 

What is the solution? Ban quacks or train them?:

The critical gap in India’s public healthcare system has led many public health researchers to argue that quacks ought to be trained to supplement the government healthcare system. Abhijit Chowdhury, a professor of hepatology at the Institute of Post Graduate Medicine and Research in Kolkata and a member of West Bengal’s Liver Foundation, a non-governmental organisation, says, “People living in rural areas cannot reach out to big doctors in the city when they need them. [Unqualified healthcare providers] with virtually no training and some exposure to doctors, have been at the side of people in time of need.”

A study led by Jishnu Das, lead economist in the development research group at the World Bank, found that qualified doctors were only about 30.9 percentage points more likely than unqualified healthcare providers to treat three diseases correctly.12 Das and colleagues sent 22 coached patients to present symptoms of unstable angina, asthma, and dysentery to a cross section of unqualified and qualified doctors in six villages of Madhya Pradesh. They scored the doctors on how many of a checklist of essential diagnoses questions they asked, how often they arrived at correct diagnoses, and how often they prescribed unnecessary treatments, such as antibiotics.

The researchers found that although qualified doctors were more likely than unqualified doctors to treat diseases correctly, they were also more likely to prescribe unnecessary antibiotics—public and private doctors with MBBS qualifications prescribed antibiotics for unstable angina and asthma 48% and 45% of the time, respectively, whereas informal providers did so only about 28% of the time. This finding challenges the common perception that only quacks overtreat patients and shows that “bad practices are more likely to come from an MBBS doctor,” says Das.

Das and Chowdhury advocate a system of training unqualified doctors to administer basic care to patients and to refer patients with more difficult problems to qualified doctors.

“Most countries have multiple cadres of healthcare,” Das says. “Kenya has nurse practitioners who can diagnose and treat. Further, they have clinical officers and medical officers. The medical officers are like India’s MBBS doctors.”

Some states have already begun this practice of training quacks:

Experiments in such training are already taking place in India. The Liver Foundation and the Foundation for Health Action, non-profit organisations based in West Bengal, and the World Health Partners, based in Delhi, train unqualified practitioners to treat uncomplicated diseases such as urinary tract infections and diarrhoea. A few state governments are considering training unqualified healthcare workers to improve rural healthcare. In June 2015 Telangana revived such a programme.

Yet such programmes have met stiff resistance from medical councils, with doctors arguing that short training courses will only produce more quacks and that there is no replacement for studying medicine. “How can you compare a quack with six months’ training with people like us with 11 years of training?” asks CV Bhirmanandam, a cardiologist who sits on the executive committee of the Medical Council of India. “If [these quacks] have no permission to practise, they should be put in jail.”

Taori adds that although such ideas seem good in theory, it would be difficult in practice to ensure that unqualified medical practitioners stick to their job description. “They will push the boundaries and start treating themselves as primary physicians,” he says, adding that without punitive action to regulate such providers the experiment can’t work.

But Das says that such opposition from doctors ignores the reality that there aren’t enough qualified practitioners in rural India. “What is the other option?” he asks. “If you shut down informal providers, you will shut down 80% of our medical workforce.”

 No easy answers..

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