The Effect of Franchising Rural Private Practitioners in India on Quality of Care - A Sustainable Approach?

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While India's spending on public health is among the lowest in the world, it has one of the highest proportions of private health expenditure in the world, at over 80% of all health spending. The private sector is the major source of initial ambulatory care for the rural poor in India. In fact, private practitioners are usually the first point of contact that the rural poor have with the health system, mostly due to their extensive reach and coverage of the population. Thus, private practitioners are in a unique position to impact the health status of the poor. Thus, studies have shown the care of both officially qualified as well as informal private practitioners to be of poor quality.

The idea of collaborating with rural private practitioners in the provision of healthcare first developed after independence. Many rural private practitioners have been known to practice an eclectic blend of traditional and allopathic medicine. Assessment of the technical quality of services provided for family planning and reproductive health and assessment of patient satisfaction remain critical issues that have not been adequately addressed in past studies. While there are a handful of evaluations of the quality of care of these practitioners; thus, it is still unclear how quality of care in the private sector compares with care in the public sector, which has also been recognized to be of poor quality. Past studies have compared private practitioner treatment practices with treatment protocols, and not with actual treatment patterns in the public sector. (Peters, 2002) In addition, no studies have compared the quality of care after a training intervention with the care provided by practitioners who were not trained.