Emphasizing that India has a huge burden of diseases, philanthropist Melinda Gates favours engaging the quacks to improve their practice for the wellbeing of millions of poor. She even recognizes the quacks as entrepreneurs playing an important role in the society.

Melinda was in Bihar last month with her billionaire husband Bill Gates meeting with community health workers and villagers in the state, to which their foundation is giving $80 million dollars in grants in a partnership with the state government over the next five years.

“These doctors may not have the level of qualification that you or I are used to, and they aren’t officially recognized as medical professionals, but when someone is sick, they have to go where care is provided and where they feel safe and cared for. And in rural India, that generally means going to a quack,” she recorded on her return.

Melinda asked the hard truth — Can we ignore the fact that these quacks exist and deliver a substantial portion of the healthcare to our communities? “We have to leverage all the resources that are available in order to improve health and save lives, and this means trying to engage with quacks.”

“Private rural practitioners, or quacks, deliver the vast majority of healthcare in many countries around the world; there is a real opportunity to improve the health and wellbeing of millions of poor families if we can figure out how to best engage with these providers to improve their practice,” she wrote on her foundation site.

Melinda, co-chair of the Bill & Melinda Gates Foundation, said she is working with the Bihar Government to engage the quacks and improve the quality of care, in part by linking them electronically to a network of qualified providers who are available 24/7 to provide advice and facilitate referral when necessary.

Excerpts from Melinda’s post:

I was in India last month and had the opportunity to meet Mr. Nagendra in Jamsaut village – a small village in a rural part of the state of Bihar, in Northern India.  Mr. Nagendra is a private healthcare provider who runs a private practice for villagers. He utilizes a mix of practices along with good “bedside manner” that engenders the trust of the people.

Mr. Nagendra’s story is an important one because all across India, particularly in the northern states, there are millions of entrepreneurs just like him – about one per village – who are providing the majority of healthcare in the country.  In rural India, about 80-90 per cent of healthcare is provided by these private local providers with no formal training, often called Rural Medical Practitioners (RMPs).

These “quack” doctors provide a range of basic family health services, such as treating pneumonia, diarrhea, or a variety of ailments in adults, such as hypertension and diabetes, as well as newborn conditions such as sepsis. They combine different approaches to medicine, using allopathic (western, evidence-based medicine), aruvedic (Indian traditional healing arts) and herbal treatments.

When RMPs recognize that a patient’s case is beyond their ability to help, they may refer these difficult cases to more qualified doctors, with whom they often have some sort of reciprocal relationship – “you train me and I’ll refer you the cases I can’t handle.” However, the range of their services is impressive; RMPs often provide antibiotics, intravenous fluids, and contraceptives, and even deliver babies.