Preprint / Version 1

Informal rural healthcare providers in North and South India

Authors

  • Meenakshi Gautham London School of Hygiene and Tropical Medicine, London, UK, 2Centre for Research in New International Economic Order, Chennai, India, 3Garhwal Community Development and Welfare Society, Tehri Garhwal, Uttarakhand, India and 4Institute of Development Studies, Brighton, UK
  • K Shyamprasad London School of Hygiene and Tropical Medicine, London, UK, 2Centre for Research in New International Economic Order, Chennai, India, 3Garhwal Community Development and Welfare Society, Tehri Garhwal, Uttarakhand, India and 4Institute of Development Studies, Brighton, UK
  • Rajesh Singh London School of Hygiene and Tropical Medicine, London, UK, 2Centre for Research in New International Economic Order, Chennai, India, 3Garhwal Community Development and Welfare Society, Tehri Garhwal, Uttarakhand, India and 4Institute of Development Studies, Brighton, UK
  • Anshi Zachariah London School of Hygiene and Tropical Medicine, London, UK, 2Centre for Research in New International Economic Order, Chennai, India, 3Garhwal Community Development and Welfare Society, Tehri Garhwal, Uttarakhand, India and 4Institute of Development Studies, Brighton, UK
  • Rajkumari Singh London School of Hygiene and Tropical Medicine, London, UK, 2Centre for Research in New International Economic Order, Chennai, India, 3Garhwal Community Development and Welfare Society, Tehri Garhwal, Uttarakhand, India and 4Institute of Development Studies, Brighton, UK
  • Gerald Bloom London School of Hygiene and Tropical Medicine, London, UK, 2Centre for Research in New International Economic Order, Chennai, India, 3Garhwal Community Development and Welfare Society, Tehri Garhwal, Uttarakhand, India and 4Institute of Development Studies, Brighton, UK

Keywords:

Informal providers, rural, India, healthcare, knowledge, Uttarakhand, Andhra Pradesh, health markets

Abstract

Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south). We mapped and interviewed IPs in all nine blocks of Tehri and in nine out of 57 blocks in Guntur, and then interviewed a smaller sample in depth (90 IPs in Tehri, 100 in Guntur) about market practices, relationships with the formal sector, and their knowledge of protocol-based management of fever, diarrhoea and respiratory conditions. We evaluated IPs’ performance by observing their interactions with three patients per condition; nine patients per provider. IPs in the two districts had very different educational backgrounds—more years of schooling followed by various informal diplomas in Tehri and more apprenticeships in Guntur, yet their knowledge of management of the three conditions was similar and reasonably high (71% Tehri and 73% Guntur). IPs in Tehri were mostly clinic-based and dispensed a blend of allopathic and indigenous drugs. IPs in Guntur mostly provided door-to-door services and prescribed and dispensed mainly allopathic drugs. In Guntur, formal private doctors were important referral providers (with commissions) and source of new knowledge for IPs. At both sites, IPs prescribed inappropriate drugs, but the use of injections and antibiotics was higher in Guntur. Guntur IPs were well organized in state and block level associations that had successfully lobbied for a state government registration and training for themselves. We find that IPs are firmly established in rural India but their role has grown and evolved differently in different market settings. Interventions need to be tailored differently keeping in view these unique features. Keywords: Informal providers, rural, India, healthcare, knowledge, Uttarakhand, Andhra Pradesh, health markets

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