New Delhi, Oct. 7: Doctors and economists working in Bengal have demonstrated that unqualified healthcare providers can be trained to improve their responses to patients in rural areas bereft of doctors, but angered the Indian Medical Association (IMA) that labels such providers as "quacks".
A study by the US-based economists and doctors in Calcutta has found that 72 training classes spread over nine months can help improve the ability of unqualified practitioners in Bengal's Birbhum district to manage three limited conditions - diarrhoea, chest pain and respiratory distress.
The researchers assert that the training was not in any way intended to encourage the unqualified practitioners to view themselves as substitutes for doctors, but only to empower them with information to avoid doing harm to patients who seek treatment for them.
"This was a precondition for training - that they should never call themselves doctors," Abhijit Chowdhury, a gastroenterologist at the Institute of Post-Graduate Medical Education and Research, Calcutta, and team member. "We wanted to find out whether absolutely untrained self-proclaimed practitioners, possibly engaged in unscientific and harmful practices, could be enriched with information so that they will do less harm than before," he told The Telegraph .
The study's findings have prompted the Bengal government to order a scale-up of the training. Chowdhury said about 2,000 more of such unqualified practitioners across rural areas in the state are likely to receive the training designed by The Liver Foundation, a public health organisation based in Bengal, in the coming months.
In the first phase of the government-supported study, the researchers provided lessons in anatomy, symptoms of common health disorders, the adverse effects of drugs, and the recognition of serious conditions to 152 unqualified practitioners, while using a group of 152 as controls.
The researchers then sent "mystery" or decoy patients to all 304 practitioners, each decoy well rehearsed to complain about specific sets of symptoms. "The rigor of the evaluation was such that the trainers did not know what disease the mystery patients would complain about and thus could not prepare the practitioners for specific illnesses," said Jishnu Das, lead ecomomist with the World Bank, Washington DC, and lead author of the study to be published on Friday in the US journal Science.
They found that while training improved the ability of practitioners to correctly diagnose and manage multiple conditions, it did not reduce their likelihood of providing unnecessary medicines or antibiotics. But training also did not increase unncessary use of medicines.
The training appeared to slightly narrow the gap between the quality of care patients get from untrained unqualified practitioners and the qualify of care they get from qualified healthcare workers in primary health centres in India's rural areas.
The researchers say the care patients receive in primary health centres is itself far from adequate.
"We're not solving any deep problem, the training only helps them (unqualified providers) get closer to what is an unambitious benchmark," Abhijit Banerjee, professor of economics at the Massachusetts Institute of Technology, a senior member of the research team, told this newspaper in a telephone interview.
A senior official of the IMA, a private body of doctors that describes unqualified practitioners as "quacks", said the Bengal study should be condemned as it is a "criminal activity" to train unqualified practitioners who have the potential to harm patients.
But the researchers say the study does not show any evidence of additional harm.
"Training certainly does not worsen the quality of care as been argued by members of the IMA - instead, we see improvements," Das said. The low cost of training suggests that it would cost the same to appoint 11 additional MBBS doctors in primary health centres as training 360 unqualified practitioners every year.
