PerspectiveHEALTH CARE

A pragmatic way forward?

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Science  07 Oct 2016:
Vol. 354, Issue 6308, pp. 34-35
DOI: 10.1126/science.aai8652

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Many health care providers in India have no formal medical training, despite regulations prohibiting informal practice. Although such informal providers typically offer poor-quality services, they are used by more than half of the population for out-patient care (1, 2). A well-performing public sector might be expected to outcompete informal providers, putting them out of business (3), but the delivery of primary health care in India is generally considered to be weak (4). Some argue for accepting the reality on the ground and engaging with the informal sector, at least in the short term. On page 80 of this issue, Das et al. (5) show that a training intervention with 304 informal care providers in West Bengal, India, led to improved case management but had no effect on inappropriate drug prescriptions.