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.
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*Ph. D. from the Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi,

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