Unqualified health care providers or quacks, the most important piece in the rural health care jigsaw, need immediate training and regular monitoring before being formally inducted into the system. This was the opinion expressed by all doctors at a conference on Sunday.
The session on the Alipore campus of Calcutta University was organised by Liver Foundation, West Bengal ' one of the organisations working with the rural health care providers (RHCPs) in Bengal ' in association with the Myers Squibb Foundation, US.
"There is an obvious supply-side shortage in the government health care set-up. And that is leading to the proliferation of quacks," said Meenakshi Gautam, involved in the training of quacks in Uttarakhand and Andhra Pradesh.
"There is another reason, though. Bad roads across rural India force villagers to look for check-up options closer home."
Industry estimates put the number of quacks at 2 lakh in the 38,000 villages of Bengal (the national count is around 15 lakh). The number of registered doctors in the state is around 40,000.
Doctors said the quacks should be trained in "professional practices" and taught when to refer patients to government hospitals.
"Otherwise, they would continue to inflict damage on patients inadvertently, as is often the case. There is little doubt that they need training," Gautam added.
Several panellists observed that quacks ' most of them former compounders attached to private practitioners or self-taught ' had to be on a "harm reduction" mode.
"The rural health service providers are prone to advising too many antibiotics. Some of them are even performing surgeries, a specialist's job," said physician Sanjiv Mukherjee.
"They (the quacks) need to be convinced about their limitations and told about dangers wrong treatment can lead to."
Research shows that an increase in the number of qualified doctors in a state brings down the cost of consulting medical practitioners in cities where they tend to flock.
"The situation in rural areas remains the same," said surgeon Krishnendu Mukhejee, who sometimes takes specialists to his native village in Howrah to train around 30 local quacks.
"Once the training is over, the quacks must be drawn into some government programme or private project," said Chowdhury.
J-PAL, economist Abhijit Vinayak Banerjee's organisation committed to poverty alleviation, performed an assessment of 308 quacks in Suri, Birbhum, some months ago for Liver Foundation.
The organisation will recommend training for half the quacks.
"During and after the training, we will continue to evaluate the progress of both groups ' those being trained and those not being trained. At the end, we will get vital information like if there has been an increase in the number of patients the newly trained professionals are getting and if they have improved from before. This will be juxtaposed against information collected from their untrained counterparts," said Banerjee.
"A recent World Bank study, yet to be published, has found that 70 per cent of rural health care in India is provided by RHCPs," said Abhijit Chowdhury of Liver Foundation.