A nine-month-long training for informal providers has been found to be effective in improving the quality of healthcare delivery, prompting the West Bengal government to scale up the programme across the state.
A study, by Abhijit Banerjee (J-Poverty Action Lab, MIT) along with co-authors Abhijit Chowdhury (Liver Foundation), Jishnu Das (World Bank), and Reshmaan Hussam (Yale), evaluated the benefits of a nine-month-long training programme on the quality of care provided by informal healthcare providers.
The results of the study, published in October 2016 in the journal Science, showed there were substantial improvements in both knowledge and practice among the providers.
Using a randomised evaluation methodology, researchers selected 152 of the 304 informal providers from 203 villages in Birbhum (WB) to participate in the training. The structured curriculum covered topics such as physiology, drug use and abuse, emergency medical care, childcare and antenatal care, as well as public health programmes.
The study found that those trained were more likely to correctly manage a case as well as complete recommended checklists of history questions and examinations. The training also closed half of the gap in correct case management relative to the public sector.
Informal practitioners form a majority of India’s rural healthcare workforce, addressing patient healthcare needs where government sources may be less accessible. With no formal medical training, they treat more than 70% of patients at the primary level, especially in villages.
As the source of primary care, these providers offer a range of services, including treating patients with conditions that can be managed in a primary care setting, referring those with serious conditions to higher level care, and diagnosing and managing others with chronic conditions.
“This study provides robust evidence on this ongoing debate and shows that medical training can be an effective strategy for improving the quality of care provided by informal providers,” said Banerjee.
The training programme was designed and implemented by Liver Foundation.
The training of the first batch of 2,000 practitioners over a six-month period is in the process of being rolled out across 35 centres in West Bengal. Rural healthcare providers will be trained in batches of 50 by nurses teaching at nursing-training centres across the state.
“This study is not only relevant for West Bengal but for other states too, such as Madhya Pradesh and Uttar Pradesh, as the structure of the informal provider market is often found to be similar – both in terms of their widespread presence in the community and the knowledge gaps they face,” Banerjee said.