BACKGROUND
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India’s booming healthcare industry hides a glaring contradiction. Whereas 70% of the country’s population is still rural, more than 70% of its 700,000 registered doctors work in the urban and affluent private health care sector, or have migrated overseas.

The entire rural public health delivery system employs less than 50,000 doctors and rural health facilities are plagued by chronic staff shortages, absenteeism and ghost workers. Urban educated medical graduates are unwilling to work in rural areas due to poor working and living conditions and lack of supportive human resource policies. The focus of medical education is on academic excellence and super specializations at the expense of a social or rural orientation.

Meanwhile, nearly 700 million rural Indians continue to suffer a high burden of mortality and preventable diseases. Much of this pain and suffering can be reduced by simple primary level interventions delivered by well informed and well linked mid-level practitioners, not necessarily University graduates.

A number of important studies, including a nationwide one by UNICEF have shown that primary health care in rural areas is delivered mainly by semi-trained or informally trained health providers who provide first aid and basic health care for minor illnesses. Being local residents they are easily available and well integrated within their local communities.

Recognising the potential of this private informal health sector, India’s health policies as articulated by the National Rural Health Mission and the Eleventh Five Year Plan, have called for innovative partnerships with rural health providers to improve quality of care at the frontlines.