India’s informal doctors: Assets, not quacks

Jishnu Das of World Bank chips in to support India’s several informal doctors:

 

This reality on the ground is more startling than even those who support IP training are willing to cede.

Part of this reflects the abysmal training and practices of many supposedly qualified doctors in India. But part of it is also because IPs are seldom people who just closed the vegetable shop and opened a clinic. As we show in forthcoming research, 91% have received training, either by working in a clinic or as a pharmacist, or through some sort of observation in clinics and hospitals. This is a model of practical training, rather than formal medical education.

Whatever the reasons, the stark reality is that IPs are the backbone of India’s primary healthcare system. Our research clearly shows that their services are comparable with or better than alternatives in rural areas. Training can increase their knowledge base and, by extension, the quality of care available for millions of poor Indians.

I understand the anxiety around this: people are nervous about heading down an uncertain path that opens up a host of regulatory and conceptual problems. There is also the issue of challenging the authority of medical doctors, and the notion, enshrined in public health psyche, that qualifications are a proxy for quality.

And critical questions remain. What if training grants ‘official’ legitimacy to IPs, empowering them to give more antibiotics and try out dangerous procedures? And would training them take pressure off the state to provide decent public healthcare to poor people?

No one knows. We have never even tried to systematically evaluate the costs and benefits of training IPs. But given the evidence of their role, this is now a critical task.

Actually given how so called formal directors have been conducting their practice (sorry business), one is not sure how bad informal doctors actually are.