Informal healthcare providers in India: Illegal and indispensable

Abstract

The corresponding author who served in Supaul district of Bihar state of India as an Acute Flaccid Paralysis(AFP) Surveillance Medical Officer(SMO) with the World Health Organisation between May 2011 and July 2013,observed that the district had a preponderance of quackery. A look at the public healthcare system in the district with a population of 2.2 million shows just why this situation exists. According to the latest data available on government websites, the shortfall of Health Sub Centres, Primary Health Centres and Community Health Centres in Supaul district is an astonishing 58%,87% and 88% respectively. These numbers are not significantly different from the numbers for the rest of the state of Bihar. There is no evidence of any political will to tackle this shocking shortfall. The Bihar government has actually reduced the allocation to health for the financial year 2017-18 to Rs.7001.52 crore from Rs.8234.70 crore in 2016-17.Estimates say 70 to 80 percent of healthcare providers in India are informal providers. This ratio can go upto 30 informal providers for every public sector doctor in certain rural areas. Upto 75 percent of primary care visits in rural areas can be to an informal provider. If we must have equitable access to healthcare in India,it would be imperative to involve these informal providers.