Would you want to be treated by a doctor who wasn’t qualified?
Most, if not all, people would surely respond ‘no.’ Doctors have a considerable degree of power over their patients. To vest this power in somebody with no formal medical training would be a hugely alarming prospect for the majority of people.
And yet, in India, many people do this – albeit by necessity, rather than choice.
The number of people who are unqualified, untrained and unregistered but still practise medicine as doctors in the country is estimated to be 1 million, though it could be as high as 2.5 million. In many states, the number of unqualified medical practitioners outnumber the qualified doctors who are practising.
Now, a charity in West Bengal – where there is an enormous shortage of health centres – says that these doctors should be given proper training. They have suggested that this is one way of fixing India’s chronic shortage of doctors, and that the benefits would largely be felt by rural communities.
As we have reported in the past, other NGOs such as World Health Partners have developed innovative schemes for combining the reach of unlicensed practitioners with access to expert care.
India has a doctor-patient ratio of approximately 1 : 1,700 – falling far short of the World Health Organization’s (WHO) recommended ratio of
1 : 1,000. Patients who live in rural areas – this accounts for approximately 70 percent of Indians – suffer even more: just 20 percent of Indian doctors work in rural areas.
Aside from shortages, India’s healthcare system is dogged by absenteeism among its doctors. “Is There a Doctor in the House? Medical Worker Absence in India” – a 2011 study carried out by American researchers – found that “nearly 40% of doctors and medical service providers are absent from work on a typical day.”
The paper noted that this was “not concentrated among a few doctors” but “quite widely distributed” and especially pronounced in remote areas with a poor quality of infrastructure – again indicative that the problem has a particularly damaging effect on rural India.
This gap is being filled by unqualified doctors – popularly known as ‘quacks.’ These self styled doctors are often vilified as irresponsible fraudsters who endanger the wellbeing of the general public. They are blamed for excessively prescribing antibiotics; unsafe, unhygienic practises; and even corruption.
The prevailing attitude towards ‘quacks’ is probably most adequately summarised by a 1996 Supreme Court ruling
“A person who does not have knowledge of a particular System of Medicine but practices in that System is a Quack and a mere pretender to medical knowledge or skill, or to put it differently, a Charlatan.”
Dr. Abhijit Choudhary disagrees. Whilst conceding that these ‘quacks’ are “untrained”, Choudhary notes “in the dead of night, they are by the side of the people of the village when they are in trouble.”
A study published in Science magazine claims that “health care providers without formal medical training and self-declared “doctors” are sought for up to 75% of primary care visits”, adding that “this reflects the absence of trained medical professionals in rural locations.” In many regions, “informal providers are the only proximate source of health care.”
Many have argued that the training of unqualified practitioners is important to improve their practises. Cardiologist Sanjiv Mukherjee commented, “the rural health service providers…need to be convinced about their limitations and told about the dangers wrong treatment can lead to.”
Choudhary has acknowledged this, but maintained that “if I can reduce the negative attributes [of ‘quacks’] by 10 percent and increase the positive by 12 percent, it is a net societal benefit.”
Choudhary also plans for unqualified doctors to be registered with the local district health and medical officer so that, in instances of malpractice, they are able to be held to account. In Choudhary’s own words, “right now, everybody has closed their eyes to them. If this training program is given, they will become visible.”
However, the Indian Medical Association, which represents licensed doctors, have been vehement in their criticism. They have accused the Liver Foundation of training unqualified doctors “to do illegal things more scientifically.” Others have stated that training will instead detract from efforts to improve healthcare delivery and infrastructure in rural areas.
The Indian Telegraph reported that “training appeared to slightly narrow the gap” in quality of care from unqualified and qualified medical practitioners. It noted that, with training, the ability of many ‘quacks’ to diagnose and manage conditions improved, though it did not stop them from unnecessarily prescribing drugs.
What is certain that, for the many millions of Indians whose healthcare provision is so mediocre they must seek the potentially unreliable and even dangerous advice of unqualified doctors, there must be a swift and substantive response. Practical solutions must be put on the table to make much needed improvements.
We have already seen India ranked 143 out of 188 countries on a global health index, in an unsubtle indication of the inadequacies and mismanagement of India’s healthcare system. If the training of unqualified doctors is the best solution that’s being offered, it surely must come as the latest in a series of wake-up calls that this cannot be allowed to continue.