IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v84y2013icp30-34.html
   My bibliography  Save this article

Which doctor for primary health care? Quality of care and non-physician clinicians in India

Author

Listed:
  • Rao, Krishna D.
  • Sundararaman, T.
  • Bhatnagar, Aarushi
  • Gupta, Garima
  • Kokho, Puni
  • Jain, Kamlesh

Abstract

The scarcity of rural physicians in India has resulted in non-physician clinicians (NPC) serving at Primary Health Centers (PHC). This study examines the clinical competence of NPCs and physicians serving at PHCs to treat a range of medical conditions. The study is set in Chhattisgarh state, where physicians (Medical Officers) and NPCs: Rural Medical Assistants (RMA), and Indian system of medicine physicians (AYUSH Medical Officers) serve at PHCs. Where no clinician is available, Paramedics (pharmacists and nurses) usually provide care. In 2009, PHCs in Chhattisgarh were stratified by type of clinical care provider present. From each stratum a representative sample of PHCs was randomly selected. Clinical vignettes were used to measure provider competency in managing diarrhea, pneumonia, malaria, TB, preeclampsia and diabetes. Prescriptions were analyzed. Overall, the quality of medical care was low. Medical Officers and RMAs had similar average competence scores. AYUSH Medical Officers and Paramedicals had significantly lower average scores compared to Medical Officers. Paramedicals had the lowest competence scores. While 61% of Medical Officer and RMA prescriptions were appropriate for treating the health condition, only 51% of the AYUSH Medical Officer and 33% of the prescriptions met this standard. RMAs are as competent as physicians in primary care settings. This supports the use of RMA-type clinicians for primary care in areas where posting Medical Officers is difficult. AYUSH Medical Officers are less competent and need further clinical training. Overall, the quality of medical care at PHCs needs improvement.

Suggested Citation

  • Rao, Krishna D. & Sundararaman, T. & Bhatnagar, Aarushi & Gupta, Garima & Kokho, Puni & Jain, Kamlesh, 2013. "Which doctor for primary health care? Quality of care and non-physician clinicians in India," Social Science & Medicine, Elsevier, vol. 84(C), pages 30-34.
    • Handle: RePEc:eee:socmed:v:84:y:2013:i:c:p:30-34
    DOI: 10.1016/j.socscimed.2013.02.018
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613000919
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2013.02.018?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Das, Jishnu & Hammer, Jeffrey, 2005. "Which doctor? Combining vignettes and item response to measure clinical competence," Journal of Development Economics, Elsevier, vol. 78(2), pages 348-383, December.
    2. Leonard, Kenneth L. & Masatu, Melkiory C., 2005. "The use of direct clinician observation and vignettes for health services quality evaluation in developing countries," Social Science & Medicine, Elsevier, vol. 61(9), pages 1944-1951, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Sujatha, V., 2023. "Of informal practitioners of biomedicine. The interplay of medicine, economy and society in India," Social Science & Medicine, Elsevier, vol. 317(C).
    2. Krishna D Rao & Mandy Ryan & Zubin Shroff & Marko Vujicic & Sudha Ramani & Peter Berman, 2013. "Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-9, December.
    3. Kailthya, Subham & Kambhampati, Uma, 2022. "Political competition and public healthcare: Evidence from India," World Development, Elsevier, vol. 153(C).
    4. Bhaskarabhatla, Ajay & Chatterjee, Chirantan, 2017. "The role of physicians in prescribing irrational fixed-dose combination medicines in India," Social Science & Medicine, Elsevier, vol. 174(C), pages 179-187.
    5. Rahi Jain & Bakul Rao, 2016. "Taxonomy of Challenges in Medical Laboratory Diagnostic Services," Proceedings of International Academic Conferences 3506096, International Institute of Social and Economic Sciences.
    6. Rao, Krishna D. & Mehta, Akriti & Kautsar, Hunied & Kak, Mohini & Karem, Ghassan & Misra, Madhavi & Joshi, Harsha & Herbst, Christopher H. & Perry, Henry B., 2023. "Improving quality of non-communicable disease services at primary care facilities in middle-income countries: A scoping review," Social Science & Medicine, Elsevier, vol. 320(C).
    7. Das, Jishnu & Daniels, Benjamin & Ashok, Monisha & Shim, Eun-Young & Muralidharan, Karthik, 2022. "Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy," Social Science & Medicine, Elsevier, vol. 301(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Anna D Gage & Margaret E Kruk & Tsinuel Girma & Ephrem T Lemango, 2018. "The know-do gap in sick child care in Ethiopia," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-10, December.
    2. Alaka Holla & Jishnu Das & Aakash Mohpal & Karthik Muralidharan, 2015. "Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India," Working Papers id:7219, eSocialSciences.
    3. Jishnu Das & Alaka Holla & Aakash Mohpal & Karthik Muralidharan, 2016. "Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India," American Economic Review, American Economic Association, vol. 106(12), pages 3765-3799, December.
    4. Christophe Lemiére & Gaute Torsvik & Ottar Mæstad & Christopher H. Herbst & Kenneth L. Leonard, 2013. "Evaluating the Impact of Results-Based Financing on Health Worker Performance: Theory, Tools and Variables to Inform an Impact Evaluation," Health, Nutrition and Population (HNP) Discussion Paper Series 98269, The World Bank.
    5. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
    6. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    7. Banuri, Sheheryar & de Walque, Damien & Keefer, Philip & Haidara, Ousmane Diadie & Robyn, Paul Jacob & Ye, Maurice, 2018. "The use of video vignettes to measure health worker knowledge. Evidence from Burkina Faso," Social Science & Medicine, Elsevier, vol. 213(C), pages 173-180.
    8. Rao, Krishna D. & Sheffel, Ashley, 2018. "Quality of clinical care and bypassing of primary health centers in India," Social Science & Medicine, Elsevier, vol. 207(C), pages 80-88.
    9. Alfredo Paloyo & Arndt Reichert, 2017. "Biting Back at Malaria: Assessing Health-service Providers' Compliance with Treatment Guidelines," Review of Development Economics, Wiley Blackwell, vol. 21(3), pages 591-626, August.
    10. Gulati, Namrata & Ray, Tridip, 2016. "Inequality, neighbourhoods and welfare of the poor," Journal of Development Economics, Elsevier, vol. 122(C), pages 214-228.
    11. Pablo A. Celhay & Paul J. Gertler & Paula Giovagnoli & Christel Vermeersch, 2019. "Long-Run Effects of Temporary Incentives on Medical Care Productivity," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 92-127, July.
    12. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    13. Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Professionalism, Latent Professionalism and Organizational Demands for Health Care Quality in a Developing Country," Working Papers 42883, University of Maryland, Department of Agricultural and Resource Economics.
    14. Kenneth L. Leonard & Melkiory C. Masatu & Alexandre Vialou, 2007. "Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality," Journal of Human Resources, University of Wisconsin Press, vol. 42(3).
    15. Das, Jishnu & Hammer, Jeffrey & Sánchez-Paramo, Carolina, 2012. "The impact of recall periods on reported morbidity and health seeking behavior," Journal of Development Economics, Elsevier, vol. 98(1), pages 76-88.
    16. Ashish Arora & Michelle Gittelman & Sarah Kaplan & John Lynch & Will Mitchell & Nicolaj Siggelkow & Robert J. Carroll & David M. Primo & Brian K. Richter, 2016. "Using item response theory to improve measurement in strategic management research: An application to corporate social responsibility," Strategic Management Journal, Wiley Blackwell, vol. 37(1), pages 66-85, January.
    17. World Bank & Oxford Policy Management, 2015. "Health Worker Survey in Timor-Leste," World Bank Publications - Reports 23879, The World Bank Group.
    18. Das, Jishnu & Daniels, Benjamin & Ashok, Monisha & Shim, Eun-Young & Muralidharan, Karthik, 2022. "Two Indias: The structure of primary health care markets in rural Indian villages with implications for policy," Social Science & Medicine, Elsevier, vol. 301(C).
    19. Friedman, Willa & Keats, Anthony & Mutua, Martin Kavao, 2022. "Disruptions to healthcare quality and early child health outcomes: Evidence from health-worker strikes in Kenya," Journal of Health Economics, Elsevier, vol. 86(C).
    20. Sautmann,Anja & Brown,Samuel & Kline,Dean Mark, 2020. "Subsidies, Information, and the Timing of Children’s Health Care in Mali," Policy Research Working Paper Series 9486, The World Bank.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:84:y:2013:i:c:p:30-34. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.