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

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  • 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
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    References listed on IDEAS

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    1. 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.
    2. 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.
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    2. 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.
    3. Sujatha, V., 2023. "Of informal practitioners of biomedicine. The interplay of medicine, economy and society in India," Social Science & Medicine, Elsevier, vol. 317(C).
    4. Kailthya, Subham & Kambhampati, Uma, 2022. "Political competition and public healthcare: Evidence from India," World Development, Elsevier, vol. 153(C).
    5. 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).
    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. 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.

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