Much health care in rural India comes from unqualified practitioners
http://www.100md.com
《英国医生杂志》
Public and private healthcare facilities that purport to serve poor people in rural parts of India are increasingly catching the attention of researchers. A survey conducted by US researchers in Udaipur, Rajasthan, now provides hard data showing the nature of the availability of health care in rural India.
The researchers, Dr Abhijit Banerjee and Dr Esther Duflo from the Massachusetts Institute of Technology and Dr Angus Deaton from Princeton University, all working under the aegis of the institute抯 Poverty Action Lab, found widespread symptoms of disease among the people surveyed.
Given the state of the public facilities, the main sources of health care are private practitioners and traditional faith healers (bhopas). However, such practitioners are largely untrained and unregulated, said Dr Banerjee. His team found that 41% of those in the private sector who called themselves doctors said they had no medical degree, 18% had no medical or paramedical training at all, and 17% had not even graduated from high school. In 68% of visits to private clinics or practices patients were given an injection and in 12% patients were given a drip, compared with 32% and 6% in public facilities. Only 4% of visits to private facilities led to a laboratory test for diagnosis.
The study also showed that on average 45% of medical or paramedical personnel were absent from government run sub-centres (serving a practice population of about 3600) and 36% were absent from the larger primary health centres (serving 48 000). The sub-centres were closed 56% of the time during their regular opening hours, at unpredictable times, discouraging people from walking an average of 1.4 miles from their village.
揟he situation does not seem specific to Udaipur: these results are similar to absenteeism rates found in nationally representative surveys in India and Bangladesh,?the researchers said.
While patients should be getting free medicines at the public facilities, this was not always the case. Hence poor people rely less than the better off patients on the public facilities, say the researchers.
揟hese data paint a fairly bleak picture: villagers?health is poor; the quality of public service is abysmal; private providers—unregulated and for the most part unqualified—provide the bulk of health care in the area,?say the researchers.
Responding to the results of the survey, Seva Mandir, a local non-governmental organisation working on rural and tribal developmental issues, is now implementing four new experimental interventions to address key healthcare problems.
揥e will evaluate all of them, and, based on the findings, some or perhaps all of them will be expanded over the next few years,?Dr Banerjee said. To aid evaluation each intervention is being introduced in a random set of villages, as in a medical trial, he added.(New Delhi, Sanjay Kumar)
The researchers, Dr Abhijit Banerjee and Dr Esther Duflo from the Massachusetts Institute of Technology and Dr Angus Deaton from Princeton University, all working under the aegis of the institute抯 Poverty Action Lab, found widespread symptoms of disease among the people surveyed.
Given the state of the public facilities, the main sources of health care are private practitioners and traditional faith healers (bhopas). However, such practitioners are largely untrained and unregulated, said Dr Banerjee. His team found that 41% of those in the private sector who called themselves doctors said they had no medical degree, 18% had no medical or paramedical training at all, and 17% had not even graduated from high school. In 68% of visits to private clinics or practices patients were given an injection and in 12% patients were given a drip, compared with 32% and 6% in public facilities. Only 4% of visits to private facilities led to a laboratory test for diagnosis.
The study also showed that on average 45% of medical or paramedical personnel were absent from government run sub-centres (serving a practice population of about 3600) and 36% were absent from the larger primary health centres (serving 48 000). The sub-centres were closed 56% of the time during their regular opening hours, at unpredictable times, discouraging people from walking an average of 1.4 miles from their village.
揟he situation does not seem specific to Udaipur: these results are similar to absenteeism rates found in nationally representative surveys in India and Bangladesh,?the researchers said.
While patients should be getting free medicines at the public facilities, this was not always the case. Hence poor people rely less than the better off patients on the public facilities, say the researchers.
揟hese data paint a fairly bleak picture: villagers?health is poor; the quality of public service is abysmal; private providers—unregulated and for the most part unqualified—provide the bulk of health care in the area,?say the researchers.
Responding to the results of the survey, Seva Mandir, a local non-governmental organisation working on rural and tribal developmental issues, is now implementing four new experimental interventions to address key healthcare problems.
揥e will evaluate all of them, and, based on the findings, some or perhaps all of them will be expanded over the next few years,?Dr Banerjee said. To aid evaluation each intervention is being introduced in a random set of villages, as in a medical trial, he added.(New Delhi, Sanjay Kumar)