'Trained quacks' can fill up 54% medical gap, shows study

KOLKATA: They exist all over rural India providing healthcare to over half the country's population. The medical establishment may be opposed to their practice, but given the shortage of trained doctors, informal medical practitioners (IMP) or quacks as they are referred to play a crucial role.

As the debate rages on mainstreaming of IMPs, a study conducted in villages across three blocks of Birbhum shows that moderate training can improve unlicensed healthcare in addition to addressing the doctorpopulation gap. The co-authors of the study included Abhijit Banerjee, the Ford International Professor of Economics at Massachusetts Institute of Technology (MIT), Jishnu Das of World Bank, Dr Abhijit Chowdhury of the Institute of Post Graduate Medical Education and Research at SSKM Hospital, Kolkata and Reshmaan Hussam, a post-doc at Yale University .

Although a figure of 54% seeking primary care from IMPs in Bengal is less than states like Rajasthan,

Madhya Pradesh

and Andhra Pradesh, where this population is as high as 75%, it reflects the shortage of trained medical doctors in the state. Conceived and rolled out by Liver Foun dation, West Bengal, the study was supported by

West Bengal

National Rural Health Mission, World Bank's Knowledge for Change Program and a

Bristol Myers Squibb

award. The paper, The Impact of Training Informal Healthcare Providers in India: A Randomized Controlled Trial, was published in Science journal on Friday .

The study involved 304 IMPs and their nine-month training, divided into 72 sessions.The researchers used standardized patients --those playing the role of patients with chest pain, breathing problems and diarrhoea.The results show a significant improvement in terms of developing a checklist of data relevant to the medical condition of the patient (4.1percentage points), a standard practice that helps in diagnosis and patient assessment. With training, the informal providers increased their skill in correct case management, an overall measure of their decisionmaking skill in a given situation (by 7.9 percentage points). While trained IMPs still lag behind trained doctors, the training cuts that gap by half. The course was not specifically focused on just the three medical conditions but tried to improve diagnostic medical skills and decision-making. “They are no match for formally trained medical practitioners. But training IMPs to make them more competent, scientific and causing less harm to patients could be a way out,“ said Dr Abhijit Chowdhury. “They do seem to be learning,“ said Abhijit Banerjee.

Banerjee acknowledged the project represents one study , and thinks more research will be needed. Organizations like IMA is opposed to the idea, but the state will roll out training for IMPs, probably this December.