Training informal health care providers in India improved the quality of health care they offered to patients in rural regions, a new study reports. The results provide important insights as medical professionals and policymakers continue to debate how to place these informal providers in the context of the health care system. For much of the world's poor, improving healthcare delivery remains a central part of improving health. In India, where the delivery of primary health care is generally accepted to be weak, the choice for many rural residents seeking care for common conditions is to go to providers who have no formal medical training. Accepting this reality and engaging with the informal sector is thought to be one way to improve quality of care where few other alternatives exist. Here, to inform the potential of such a pursuit, Jishnu Das and colleagues evaluated the results of a randomized controlled trial involving more than 300 informal health care providers in West Bengal, some of whom were trained in 72 low-cost sessions over 9 months. Training programs focused on multiple diseases and covered a diverse range of topics from human anatomy to clinical practice. Attendance per session was 56%. Training, the researchers found, increased correct case management for ailments like angina, diarrhea, and asthma by 7.9 percentage points, compared to the control group of untrained providers. It did not, however, have a significant effect on drug prescribing behavior, including the important problem of overprescribing antibiotics. In a related Perspective, Timothy Powell-Jackson notes that whether this training "could be scaled up from a demonstration project to a state policy without diluting the effect" remains a question, though its low cost should make such a training program affordable.
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Journal
Science