In the developing world, a large portion of health care providers have no formal medical training.
Since the 1940s, India has discouraged an active role for providers without full medical training. However, such caregivers do exist because of the limited reach of formal medical providers.
Now a new study of rural India, co-authored by an MIT professor, shows that modest levels of medical training can improve the quality of health care furnished by those informal providers.
‘The medical training focuses on improving diagnostic medical skills and decision-making ability of the unlicensed, informal health care providers.’
The study, in the form of a novel field experiment conducted in the state of West Bengal, India, shows that informal care providers are more likely to handle cases correctly and compile basic checklists of patient information after undergoing about 150 hours of training over a period of months.
The study was conducted with the cooperation of 304 informal health care providers in West Bengal. The 150 hours of training the participants received was divided into 72 sessions over a nine-month period.
The researchers used "standardized patients" to conduct the study, that is, people playing the role of patients who had symptoms consistent with angina, asthma, and diarrhea."
They do seem to be learning, and they are using this knowledge," says Abhijit Banerjee, the Ford International Professor of Economics at MIT and a co-author of the study.
The experiment analyzed whether unlicensed health care providers could act adequately when faced with information pertaining to three types of illness, chest pain, breathing problems, and diarrhea, that require different types of responses.
Some cases require referrals to other providers; in other cases the primary-care providers can at least offer advice to help reduce the apparent medical problems at hand.
The low-cost experiment is now being scaled up by the state of West Bengal, to see if this approach can improve care for segments of the population that do not regularly access formal medical providers. About 54% of primary-care medical visits in West Bengal occur in these informal settings. That figure ranges as high as 75% in some other Indian states.
The paper, The Impact of Training Informal Healthcare Providers in India: A Randomized Controlled Trial
, is being published in the journal Science
"It was a state-government sponsored effort," notes Banerjee. "These people exist, so the question is, what do you do about it?"
The training course was not specifically focused on just the three illnesses but tried to improve diagnostic medical skills and decision-making more broadly.
The training did not have any effect in reducing the over-prescription of medicine and antibiotics among informal providers.
Banerjee acknowledges that the project simply represents one study, and thinks more on-the-ground research will be needed. West Bengal's scale-up of the program is being launched this fall.
'They are going to start training everybody," Banerjee says, adding that the state government has "the aim of figuring out if this is a worthwhile investment for them."