By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    What Are the Benefits of CBD?
    November 27, 2021
    How to Measure Adult Diapers- The Ultimate Guide to Picking the Right Size
    March 8, 2022
    medicine cabinet
    The Effect Of Finished Dosage Form Manufacturing In New Drugs
    July 5, 2022
    Latest News
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
    The Hidden Impact Of Stress On Your Body’s Alignment And Balance
    May 22, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Robots Are Being Programmed To Perform Spine Surgeries
    November 25, 2019
    wall street journal health policy
    Wall Street Journal Shames Itself with Health Policy Coverage
    January 1, 2014
    senior living communities
    HealthKeeperz President Reflects on 50 Years of Healthcare
    October 9, 2022
    Latest News
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
    Top HIPAA-Compliant Messaging Apps for Healthcare Teams
    June 25, 2025
    When Healthcare Ends, the Legal Process Begins: What Families Should Know About Probate and Medical Estates
    June 20, 2025
    Preventing Contamination In Healthcare Facilities Starts With Hygiene
    June 15, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Above All, Do No Harm: The Sad State of Health Care Quality in Rural Madhya Pradesh
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Global Healthcare > Above All, Do No Harm: The Sad State of Health Care Quality in Rural Madhya Pradesh
Global Healthcare

Above All, Do No Harm: The Sad State of Health Care Quality in Rural Madhya Pradesh

Amanda Glassman
Amanda Glassman
Share
6 Min Read
SHARE

 

Today in Health Affairs, Jishnu Das, Alaka Holla, Veena Das, Manoj Mohanan, Diana Tabak, and Brian Chan publish a unique and important study on the messy realities of health care in rural areas of the extremely poor state of Madhya Pradesh in India.

 

Today in Health Affairs, Jishnu Das, Alaka Holla, Veena Das, Manoj Mohanan, Diana Tabak, and Brian Chan publish a unique and important study on the messy realities of health care in rural areas of the extremely poor state of Madhya Pradesh in India.

More Read

healthcare industry
How to Prepare Yourself for a Job in the Healthcare Industry
Paying Bills: A Novel Idea in Southern Europe
Hard choices on Health Care at Home and Away
Psychable Explains How Much Ketamine Therapy Costs
How Healthcare Is Changing to Combat the Next Deadly Pandemic

Despite their relative poverty, the citizens of Madhya Pradesh seem to use health services at fairly high rates; more than half of households sent a household member to a primary care provider in the month prior to a household survey. Of these, 8% used a public provider when seeking care, while the rest go to providers in the private sector. But as the report demonstrates, once patients arrive at a primary care provider’s office, the situation becomes troubling.

Das et al build on work that was done as a background for the World Development Report 2004, which focused on making services work for poor people.  They use a population-based sample of health care providers representative of the universe of primary care facilities –public and private- that serve rural households in rural Madhya Pradesh to assess quality of care. The authors employ an “unannounced standardized patient” –considered a gold standard in quality measurement- to present consistent cases of illness to providers and to report back on provider responses.

The study finds serious deficits in quality. Interactions between patients and providers were short (3.6 minutes on average) and the emphasis in both sectors was to give several medications to the patient as quickly as possible.

Across all cases, the correct treatment protocol was followed 30% of the time, while unnecessary or harmful treatment was prescribed or dispensed 42% of the time. Only one-third of providers articulated a diagnosis, correct or incorrect. When a diagnosis was issued, close to half were wrong, and only 12% were fully correct.

What’s going on?

Is it the lack of training of providers that explains these problems? About 67% of the sampled providers reported having no medical training at all; this figure was 63% in public clinics even though it is government policy to staff public clinics with a trained doctor. When analyzed further, provider qualifications did matter for quality, but the difference between qualified and unqualified providers explained only a small portion of the variation in quality measures, controlling for all other factors.

Was the infrastructure inadequate? Was caseload too heavy during the visit? Nope, neither factor had any significant association with any quality measure. In fact, the rural clinics were found to be relatively well-endowed in equipment and infrastructure.

The biggest difference in quality outcomes studied was explained by whether a provider was working in the private or public sector, with private providers demonstrating significantly higher performance on “percentage recommended questions and exams administered,” “giving any diagnosis,” and “giving correct treatment” even after controlling for differences in income, training and other variables.

What to do?

More and better trained human resources will likely help the situation, but the study begs the question: why would a policymaker want to expand supply in its status quo version when quality is so bad that 42% of prescribed treatments are unnecessary and even harmful?!

The woeful performance of even best trained providers suggests that provider motivation, affected by the incentive and accountability environment in which they operate, is a major obstacle to improving the quality and therefore the effectiveness of health care. Something about the private sector increases provider effort – perhaps it’s the minimal accountability relationship established by payment and desire for a return customer in a competitive environment?  This was demonstrated earlier by Paul Gertler and Christel Vermeersch, in a “knowledge-quality efficiency gap,” which shows that providers need incentives in order to perform to the best of their knowledge (see figure below).

The Government of India is beginning to spend more on health. Yet its National Rural Health Mission plans for exclusively public sector solutions and relies on the traditional strategies of training, equipment and infrastructure to improve quality.

While we wait for new cadres of health professionals to be trained, where are the interventions that could make a difference for motivation given existing providers and actual patterns of patient use? And why is the messy reality of health care so hard to acknowledge and confront?

Share This Article
Facebook Copy Link Print
Share
By Amanda Glassman
As a healthcare blogger and author, I have been writing about the latest developments in the medical field for over 10 years. My work has been featured on various online publications, including Healthline and WebMD. I am passionate about educating people on how to stay healthy through proper nutrition and exercise practices. In addition to my blog posts, I have also authored several books that focus on health topics such as dieting tips, disease prevention strategies, and mental health awareness initiatives. My goal is to provide readers with reliable information so they can make informed decisions regarding their well-being.

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Health Tips For Women
Top 5 Health Tips For Women Over 45
Women Health
July 7, 2025
car accident lawsuit
Let Your Lawyer Handle the Work Before You Pay Medical Costs
Policy & Law
July 6, 2025
women dental care
What Is a Smile Makeover and How Much Does It Cost?
Dental health
June 30, 2025
HIPAA-Compliant Messaging Apps
Top HIPAA-Compliant Messaging Apps for Healthcare Teams
Global Healthcare Policy & Law Technology
June 25, 2025

You Might also Like

Obesity: Global Problem, Local Differences

June 9, 2011

Making Prevention a Priority

December 6, 2011
eHealthGlobal HealthcareHome HealthMobile Health

Can An Medication Reminder App Boost Adherence?

April 2, 2019
Lee Aase in Dubai
Global HealthcarePublic HealthSocial Media

Mayo Clinic Center for Social Media: Lee Aase [PODCAST]

November 24, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?