The impact of training informal health care providers in India: A randomized controlled trial

• Published in: Science (American Association for the Advancement of Science) Vol. 354; no. 6308; p. 80
• Main Authors: Das, Jishnu, Chowdhury, Abhijit, Hussam, Reshmaan, Banerjee, Abhijit V.
• Format: Journal Article
• Language: English
• Published: United States American Association for the Advancement of Science 07.10.2016; The American Association for the Advancement of Science
• Subjects: Anti-Bacterial Agents; Antibiotics; Assessments; Austenitic stainless steels; Benchmarks; Caseworker Approach; Chest Pain - drug therapy; Child; Clinical trials; Control Groups; Developing countries; Diarrhea - drug therapy; Doctors; Drug Prescriptions; Drug Utilization - statistics & numerical data; Health care; Health Personnel - economics; Health Personnel - education; Health Services; Humans; India; Inservice Training; LDCs; Medical personnel; Medical services; Patient Care; Patients; Physicians; Primary Health Care; Program Costs; Public health; Quality Improvement; Randomized Controlled Trials; RESEARCH ARTICLE SUMMARY; Respiratory Distress Syndrome, Adult - drug therapy; Rural areas; Rural Population; Strategy; Training; Unnecessary Procedures - statistics & numerical data; India
• ISSN: 0036-8075; 1095-9203
• DOI: 10.1126/science.aaf7384

Many families in developing countries do not have access to medical doctors and instead receive health care from informal providers. Das et al. used “mystery” patients (trained actors) to test whether a 9-month training program improved the quality of care delivered by informal providers in West Bengal (see the Perspective by Powell-Jackson). The patients did not identify themselves to the providers and were not told which providers had participated in the training program. The results of this blinded assessment showed that medical doctors delivered better care than informal providers but that the training program closed much of the gap. Science , this issue p. 80 ; see also p. 34 Training helped informal providers deliver better care for angina, diarrhea, and asthma. [Also see Perspective by Powell-Jackson ] Health care providers without formal medical qualifications provide more than 70% of all primary care in rural India. Training these informal providers may be one way to improve the quality of care where few alternatives exist. We report on a randomized controlled trial assessing a program that provided 72 sessions of training over 9 months to 152 informal providers (out of 304). Using standardized patients (“mystery clients”), we assessed clinical practice for three different conditions to which both providers and trainers were blinded during the intervention, representative of the range of conditions that these providers normally diagnose and treat. Training increased correct case management by 7.9 percentage points (14.2%) but did not affect the use of unnecessary medicines and antibiotics. At a program cost of $175 per trainee, our results suggest that multitopic medical training offers an effective short-run strategy to improve health care.