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NEW DELHI : Healthcare in rural India rides largely on untrained people, a new study said, adding that unqualified healthcare providers in some states are better than even the trained doctors in some other states.

Three out of four health workers operate without medical qualifications in rural areas, said the study, which assumes significance against the backdrop of the coronavirus pandemic reaching the hinterland.

The study, Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy, was conducted by Georgetown University, Center for Innovation and Impact, Global Health Bureau, USAID, University of California US and Centre for Policy Research, New Delhi. It was published in the Social Science & Medicine Journal of ScienceDirect.

It said 68% of healthcare providers in rural India have no formal training and operate illegally, and outside the ambit of health policy. Primary healthcare in rural India is in the hands of providers who don’t legally exist, the study said. The researchers visited 1,519 villages in 19 Indian states to count all healthcare providers and check their quality as measured through tests of medical knowledge.

According to the study, in 2010, the average Indian village had 3.2 primary healthcare providers. Of these, 86% were in the private sector and 68% had no formal medical training. In richer states, the share of informal providers did not decrease, but quality improved, and costs were lower.

“The medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socio-economic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply," it said.

The study found that 74% of villages had at least one healthcare provider and 64% of care is sought in villages with three or more providers. Most providers (86%) are in the private sector. In terms of qualifications, of the 3,473 providers surveyed, 2,367 (68%) were informal providers in the private sector, 842 were AYUSH providers (24%) and 264 (8%) had an MBBS degree.

The greater availability of knowledgeable public sector doctors is not associated with a reduction in the prevalence of informal unqualified providers, but rather an increase in their medical knowledge, it added.

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