Structural transformation in the landscape of informal healthcare system in rural India

By Dr. Dhiman Debsarma*
Informal Medical Practitioners (IHP) are the major providers of primary healthcare services to millions of people in low and middle-income countries (LMICs). They are popularly known by several names, such as Rural Unqualified Health Practitioners (RUHPs), often called informal healthcare providers, unlicensed providers, non‐formal providers, unqualified practitioners, village doctors, and quacks across various developing countries.
In India, they have constituted 1.6 million cadres and 15 times more than qualified doctors and they contribute 70 percent of the health workforce in the country. They are illegal practitioners as per state laws. Yet, the majority of the RUHPs/IHPs are mainly engaged in the rural areas where inadequate healthcare services and poor quality of care of the Primary Healthcare Centers (PHC) and Sub‐Centers are significant concerns.
Therefore, as a result, millions of people in the rural areas in India are unsatisfied as public services are unable to fill their health demand; hence they always search for alternative healthcare providers and are often dependent on them. In these health resource deficit rural areas, the RUHPs provide outpatient consultation, health services, and home‐based care for diverse illnesses/diseases such as diarrhea, fever, reproductive health, maternity care, and childcare. However, this implies informal healthcare practitioners have constituted an informal healthcare system in LMICs. The majority of medical shops of IHPs are equipped with single buildings, and few medical apparatuses to treat the patients.
But at present the nature of the informal healthcare system has undergone significant changes. Some medical shops of IHP have converted into multi-store buildings, where qualified private doctors now conduct consultation with patients in the village settings. This shift indicates that there is both structural and functional transformation going on within the informal healthcare system in the country. These observations are supported by the author’s personal life experience as he is the son of an IHP residing in rural areas of North Dinajpur District in West Bengal, India.
The author has closely observed the transition of the IHS over the years. He has observed that the IHPs were solo practitioners just one decade back. A decade ago, IHPs were primarily solo practitioners. However, within a few years, especially following the COVID-19 pandemic, the small medical shops of IHPs in village markets have transformed into multi-store buildings resembling healthcare centers. where several qualified private doctors (general physicians, pediatrics, dentists, gynaecologists, etc) consult with the patients once or twice a week. This shift has resulted in hundreds of patients flocking to these centers for treatment. It signifies a continuous and substantial structural and functional transformation in the nature of IHPs' medical shops.
Additionally, this assertion is substantiated by the author’s practical insights gained during his Ph.D. field survey in 2021-2022. During this period, it was observed that several IHP’s medical shops are extensively utilized by Formal Medical Practitioners (FMPs) as healthcare centers for patient consultations. This evidence indicates that IHPs and FMPs (qualified private doctors) have collaboratively established a new quasi-healthcare institution, presenting an exceptional healthcare model in the rural healthcare landscape of West Bengal. It can be concluded that researchers in public health must conduct comprehensive studies on these emerging quasi-healthcare institutions, not only in West Bengal but also in other states across India. Understanding the dynamics and impacts of these models could contribute valuable insights to the enhancement of rural healthcare systems nationwide.
---
*Ph. D. from the Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi,

Comments

Urgent need to study cause of large number of natural deaths in Gulf countries

By Venkatesh Nayak* According to data tabled in Parliament in April 2018, there are 87.76 lakh (8.77 million) Indians in six Gulf countries, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE). While replying to an Unstarred Question (#6091) raised in the Lok Sabha, the Union Minister of State for External Affairs said, during the first half of this financial year alone (between April-September 2018), blue-collared Indian workers in these countries had remitted USD 33.47 Billion back home. Not much is known about the human cost of such earnings which swell up the country’s forex reserves quietly. My recent RTI intervention and research of proceedings in Parliament has revealed that between 2012 and mid-2018 more than 24,570 Indian Workers died in these Gulf countries. This works out to an average of more than 10 deaths per day. For every US$ 1 Billion they remitted to India during the same period there were at least 117 deaths of Indian Workers in Gulf ...

A comrade in culture and controversy: Yao Wenyuan’s revolutionary legacy

By Harsh Thakor* This year marks two important anniversaries in Chinese revolutionary history—the 20th death anniversary of Yao Wenyuan, and the 50th anniversary of his seminal essay "On the Social Basis of the Lin Biao Anti-Party Clique". These milestones invite reflection on the man whose pen ignited the first sparks of the Great Proletarian Cultural Revolution and whose sharp ideological interventions left an indelible imprint on the political and cultural landscape of socialist China.

History, culture and literature of Fatehpur, UP, from where Maulana Hasrat Mohani hailed

By Vidya Bhushan Rawat* Maulana Hasrat Mohani was a member of the Constituent Assembly and an extremely important leader of our freedom movement. Born in Unnao district of Uttar Pradesh, Hasrat Mohani's relationship with nearby district of Fatehpur is interesting and not explored much by biographers and historians. Dr Mohammad Ismail Azad Fatehpuri has written a book on Maulana Hasrat Mohani and Fatehpur. The book is in Urdu. He has just come out with another important book, 'Hindi kee Pratham Rachna: Chandayan' authored by Mulla Daud Dalmai.' During my recent visit to Fatehpur town, I had an opportunity to meet Dr Mohammad Ismail Azad Fatehpuri and recorded a conversation with him on issues of history, culture and literature of Fatehpur. Sharing this conversation here with you. Kindly click this link. --- *Human rights defender. Facebook https://www.facebook.com/vbrawat , X @freetohumanity, Skype @vbrawat

India's health workers have no legal right for their protection, regrets NGO network

Counterview Desk In a letter to Union labour and employment minister Santosh Gangwar, the civil rights group Occupational and Environmental Health Network of India (OEHNI), writing against the backdrop of strike by Bhabha hospital heath care workers, has insisted that they should be given “clear legal right for their protection”.

Uttarakhand tunnel disaster: 'Question mark' on rescue plan, appraisal, construction

By Bhim Singh Rawat* As many as 40 workers were trapped inside Barkot-Silkyara tunnel in Uttarkashi after a portion of the 4.5 km long, supposedly completed portion of the tunnel, collapsed early morning on Sunday, Nov 12, 2023. The incident has once again raised several questions over negligence in planning, appraisal and construction, absence of emergency rescue plan, violations of labour laws and environmental norms resulting in this avoidable accident.

Job opportunities decreasing, wages remain low: Delhi construction workers' plight

By Bharat Dogra* It was about 32 years back that a hut colony in posh Prashant Vihar area of Delhi was demolished. It was after a great struggle that the people evicted from here could get alternative plots that were not too far away from their earlier colony. Nirmana, an organization of construction workers, played an important role in helping the evicted people to get this alternative land. At that time it was a big relief to get this alternative land, even though the plots given to them were very small ones of 10X8 feet size. The people worked hard to construct new houses, often constructing two floors so that the family could be accommodated in the small plots. However a recent visit revealed that people are rather disheartened now by a number of adverse factors. They have not been given the proper allotment papers yet. There is still no sewer system here. They have to use public toilets constructed some distance away which can sometimes be quite messy. There is still no...

Women's rights leaders told to negotiate with Muslimness, as India's donor agencies shun the word Muslim

By A Representative Former vice-president Hamid Ansari has sharply criticized donor agencies engaged in nongovernmental development work, saying that they seek to "help out" marginalizes communities with their funds, but shy away from naming Muslims as the target group, something, he insisted, needs to change. Speaking at a book release function in Delhi, he said, since large sections of Muslims are poor, they need political as also social outreach.

Sardar Patel was on Nathuram Godse's hit list: Noted Marathi writer Sadanand More

Sadanand More (right) By A Representative In a surprise revelation, well-known Gujarati journalist Hari Desai has claimed that Nathuram Godse did not just kill Mahatma Gandhi, but also intended to kill Sardar Vallabhbhai Patel. Citing a voluminous book authored by Sadanand More, “Lokmanya to Mahatma”, Volume II, translated from Marathi into English last year, Desai says, nowadays, there is a lot of talk about conspiracy to kill Gandhi, Netaji Subhas Chandra Bose, and Shyama Prasad Mukherjee, but little is known about how the Sardar was also targeted.

Bihar’s land at ₹1 per acre for Adani sparks outrage, NAPM calls it crony capitalism

By A Representative The National Alliance of People’s Movements (NAPM) has strongly condemned the Bihar government’s decision to lease 1,050 acres of land in Pirpainti, Bhagalpur district, to Adani Power for a 2,400 MW coal-based thermal power project.

Counterview

Search This Blog