Delhi, Tuesday, 23 June 2020: Rural health care is one of the most important developmental challenges India faces today. It is an urgent need: most recently, the COVID-19 pandemic has exposed the deep fault lines and vulnerabilities of our public systems, particularly the health sector. But in the absence of credible data, policy decisions are divorced from what is truly happening on the ground.
The Centre for Policy Research (CPR) announced the release of a groundbreaking paper—Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy.
Co-authored by Senior Visiting Fellow, Jishnu Das along with Benjamin Daniels, Monisha Ashok, Eun-Young Shim and Karthik Muralidharan.
This critical document addresses this gap in information through the first-of-its-kind nationwide picture of rural health care.
The methodology behind Two Indias:
Two Indias is the first to use an India-wide sample, providing an in-depth and comprehensive look at health care in rural India. The authors surveyed 1,519 villages across 19 Indian states in 2009 to count all health care providers and elicit their quality as measured through tests of medical knowledge.
According to Yamini Aiyar, President & Chief Executive, CPR"The COVID-19 crisis has placed unprecedented demands on our health care, making it clear that we need to have an urgent discussion on how it needs to be structured moving forward. This crucial paper uncovers fundamental features of our rural health care system with key insights for regulation, training and capacity. It is also a testimony to CPR's unflinching commitment to rigorous research that guides policy and enables much needed reform."
The paper answers the following questions:
- What is the prevalence and quality of private health care providers in rural India?
- Why don't people in rural India have access to quality health care?
- What is the role of informal health care providers?
- How can the quality of health care systems be improved?
Some key findings of the paper include:
- 75% of villages have at least one health care provider and 64% of care is sought in villages with 3 or more providers. Most providers are in the private sector (86%) and, within the private sector, the majority are ‘informal providers' without any formal medical training. Estimates suggest that such informal providers account for 68% of the total provider population in rural India.
- There is considerable variation in quality across states, within states, and even within villages and formal qualifications are a poor predictor of quality. For instance, the medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socioeconomic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply.
- India is divided into two nations not just by quality of health care providers, but also by costs: Better performing states provide higher quality at lower per-visit costs, suggesting that they are on a different production possibility frontier. These patterns are consistent with significant variation across states in the availability and quality of medical education.
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The views shared belong to individual faculty and researchers and do not represent an institutional stance on the issue.