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
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 16, 2025
    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
  • 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
    Debunking Another Eco Scare
    August 20, 2011
    How 12 Million are Putting “The Big C” Behind Them
    September 21, 2011
    Weekly Roundup: Eyeing the Solutions
    October 23, 2011
    Latest News
    How Health Choices and Legal Actions Intersect After an Injury
    July 16, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 16, 2025
    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
  • 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

Pharmacy Trends | Top 5 Pharmacy Trends for 2016
Economies of Scale Enable Mumbai-Based Laboratory to Be Market Leader
Benefits of Outsourcing Your Medical Claims Processing
How to Develop a Career in Healthcare
Expanding Medicaid benefits for improved behavioral health care, substance abuse treatment

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

paramedics in surgical gloves and masks
How Health Choices and Legal Actions Intersect After an Injury
Health care
July 16, 2025
a woman giving a key
How Probate Planning Shapes the Future of Your Estate and Family Care
Health
July 16, 2025
a woman with kinesio tapes on her back arm
How communities and healthcare providers can address slip and fall injuries with legal awareness
Health care
July 16, 2025
healthcare providers
Hidden Injuries After An Accident: What Healthcare Providers Should Watch For
Infographics
July 15, 2025

You Might also Like

BusinessGlobal Healthcare

Comparison Shopping

January 24, 2012
public private partnerships
BusinessFinanceGlobal HealthcarePublic Health

Strengthening Global Healthcare Systems Through Public-Private Partnerships

April 8, 2015
Global Healthcare

The Formula of Driver and Demand- Indian Startups story

February 14, 2016

“Stunning Progress” but OOPs! in Afghanistan

December 23, 2011
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?