Abstract
Background
Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities.
Aim
This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India’s largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province.
Method
A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province.
Results
There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers.
Conclusion
Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations’ needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province.
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Acknowledgements
The Madhya Pradesh Basic Health Services Project, Bhopal, India and the Swedish Institute, Stockholm
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Appendix
Indian systems of medicine comprise a number of indigenous systems including ayurveda, unani, homeopathy, siddhi and other systems. Full recognized licenced physician qualifications are awarded by universities in either ayurveda, unani or homeopathy. The Department of Indian Systems of Medicines and Homoeopathy (ISM & H) was set up in Ministry of Health & Family Welfare, Government of India, in March, 1995. The department currectly functions as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy under the Ministry of Health. Details on each of the systems can be found at the official website of the Department of Indian Systems of Medicine at http://indianmedicine.nic.in/.
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De Costa, A., Eriksson, B. & Diwan, V.K. Private individual ambulatory health care providers in Madhya Pradesh province, India. J Public Health 17, 235–241 (2009). https://doi.org/10.1007/s10389-008-0245-2
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DOI: https://doi.org/10.1007/s10389-008-0245-2