To Rx or Not: Mainstreaming Informal Providers: Case

On a hot summer afternoon, there is a huge commotion around the Jawnpore District Hospital. There is passionate sloganeering by the ruling party supporters competing with protests by the opposition party activists against the alleged lack of personnel and infrastructure in the district hospital. Not far away from this hullabaloo, Grameen Arogya, a non-governmental organization, stages a satyagraha to silently protest against the official silence on dysentery deaths in the region. A motorcade of government cars enters the hospital grounds. The local leaders of the ruling party and the District Hospital Superintendent are waiting to welcome and garland Shri Jagatprakash Goel, Union Health Minister, visiting the hospital. Goel ji joins the doctors in their regular ward rounds and inspects the hospital. Then he addresses the public and the medical community including a few office bearers of the medical association (the association of registered doctors). The moment Goel ji concludes the address, Mr Das from Grameen Arogya, rushes to the podium and hands a memorandum to Goel ji. He grabs the microphone and makes an emotional account of the deplorable healthcare situation in Jawnpore. He discusses the difficulties arising due to a lack of registered doctors and rampant absenteeism in the public hospital, particularly when there is no private provider of healthcare. He proposes that the only practical way to alleviate these difficulties in providing rural healthcare is to 'mainstream the quacks' and cites a 2006 multi-national survey-based research study (Chaudhury et al., 2006). He appeals to Shri Jagatprakash Goel, the minister, to make provision for special training of informal providers (Ips), to fill the need for medical practitioners in rural areas. Supporters of the ruling party and members of the medical community run to the dais to stop Mr Das from speaking further. But the minister asks the crowd to calm down and handles the situation. He assures Grameen Arogya that he will investigate the issue.