Informal service providers in healthcare sector in India

Abstract

Healthcare sector in India is characterised by an overburdened and dilapidated public healthcare infrastructure which is unable to meet the burgeoning demand of the second most populous nation in the world. Private healthcare sector has progressed rapidly over the last few decades but it remains limited to urban centres and to those who can bear the expenses. As a result, quality healthcare remains inaccessible and unaffordable for a majority of Indians which blights the prospects of India s fabled demographic dividend. The inadequacy of healthcare is reflected very clearly in the shortage of trained human resource for health. India has 1 doctor for every 1700 people against the WHO norm of 1 doctor per 1000 people. The efficacy of the limited human resource for health that we have is further limited by the fact that it is inequitable distributed. 70% of doctors are working in cities where 30% of the population lives. This leaves rural areas where 70% of India lives, grossly underserved. Policy recommendations contained in High Level Expert Group Report or National Health Policy Draft 2015 have tried to address the human resource shortage and skewed ratio of the healthcare providers across the country by increasing production capacities in the long term and creating a cadre of Rural Health Care Practitioners from the ranks of nurses, AYUSH doctors and dentists in the interim. However, these policy interventions gloss over the presence of the Informal Service Providers (ISP) who account for at least 50% of workforce in private healthcare sector in India. They are the entrepreneurial, self-employed, unregulated medical practitioners who have not received formal training to provide the healthcare they are supplying. Despite being the first port of call for patients especially in underserved rural and less affluent urban pockets, they remain an unregulated, unacknowledged and unharnessed human resource in healthcare. This raises a very pertinent question that can the problem of shortage of human resource in healthcare sector, be addressed by upskilling ISPs and integrating them in the formal healthcare sector? The goal is to ascertain the size and nature of the ISP market in order to develop policy frameworks which will address the issues of shortage of human resource for health and presence of ISPs by enabling integration of ISPs in the mainstream healthcare sector. Another guiding principle for developing policy alternatives is successful historical and existing healthcare models employing community based outreach healthcare providers. It is evident from reviewing available literature that human resource shortage and presence of ISPs in healthcare sector in India are truths that cannot be denied. Maintaining status quo is not tenable from legal, ethical, social or economic perspectives. Stringent banning of ISPs is not practically feasible and will worsen the human resource crunch. Developing frameworks that allow upskilling and integration of ISPs as part of formal healthcare sector should be the focus of policymakers. The policy intervention chosen must be contextual to the needs and resources of a community. Development and implementation of any policy option shall also need to take all stakeholders in confidence in order to find acceptable, implementable and effective solutions.