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Do qualifications matter? A qualitative study of how villagers decide their health care providers in a developing economy

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  • Gopesh Anand
  • Dilip Chhajed
  • Shailja Shah
  • Salla Atkins
  • Vishal Diwan

Abstract

Introduction: The National Rural Health Mission (NRHM) was launched in India in 2005 to address the health needs of under-served populations in rural areas, and to support universal access to care. Despite this initiative, unaccredited informal providers (IPs) often remain patients’ first point of contact, which has led to inconsistencies in treatment, and has compromised the quality of care. Aim: To explore the factors that influence patients’ decisions about healthcare providers in rural areas of central India. Methods: Nine focus group discussions (FGDs) were held in nine villages in central India. Framework analysis using an inductive approach was used to analyse the data. Results: The crosscutting theme across the discussions was not choice but need—the need for affordable and accessible health care regardless of the provider’s qualification. Results highlighted that IPs play a pivotal role in villagers’ lives. Formal healthcare services were accessed infrequently, and mainly when a condition was judged severe or possibly even fatal. Even then, affordability was carefully weighed. Villagers’ distance from formal providers contributed to high cost and low preference of formal providers. When opting for IPs, familiarity and trust were more important to villagers than qualifications. IPs have operated in rural communities in India for a long time and have adapted their services to meet the needs, preferences, social norms, and economic conditions of villagers. Conclusion: IPs have captured a niche and are often the first contact point in rural settings even when patients ultimately are diagnosed and treated by trained doctors. Merely tackling the undersupply of qualified doctors is not effective or sufficient to impact on the rural healthcare system: the strong and prevalent influence of IPs needs to be addressed also.

Suggested Citation

  • Gopesh Anand & Dilip Chhajed & Shailja Shah & Salla Atkins & Vishal Diwan, 2019. "Do qualifications matter? A qualitative study of how villagers decide their health care providers in a developing economy," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-12, August.
    • Handle: RePEc:plo:pone00:0220316
    DOI: 10.1371/journal.pone.0220316
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    References listed on IDEAS

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    1. George, Asha & Iyer, Aditi, 2013. "Unfree markets: Socially embedded informal health providers in northern Karnataka, India," Social Science & Medicine, Elsevier, vol. 96(C), pages 297-304.
    2. May Sudhinaraset & Matthew Ingram & Heather Kinlaw Lofthouse & Dominic Montagu, 2013. "What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-12, February.
    3. Russell, Steven, 2005. "Treatment-seeking behaviour in urban Sri Lanka: Trusting the state, trusting private providers," Social Science & Medicine, Elsevier, vol. 61(7), pages 1396-1407, October.
    4. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Health care delivery in rural rajasthan," Framed Field Experiments 00120, The Field Experiments Website.
    5. Gemma Berenguer & Pinar Keskinocak & J. George Shanthikumar & Jayashankar M. Swaminathan & Luk Van Wassenhove & Emily J. Kohnke & Ujjal Kumar Mukherjee & Kingshuk K. Sinha, 2017. "Delivering Long-term Surgical Care in Underserved Communities: The Enabling Role of International NPOs as Partners," Production and Operations Management, Production and Operations Management Society, vol. 26(6), pages 1092-1119, June.
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