Besides, the clear lack of an adequate number of allopathic doctors in India, there also lurks another problem- quacks who try to take advantage of this shortage and practice medicine on their own accord. Some states however, have tried a unique solution to adress this problem- training quacks in medicine.

It is well-known that the doctor-to-patient ratio in India is clearly out of control. According to a national level study in India, there’s one allopathic doctor for about every 1400 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. The figures are especially important for rural areas where the problem is much more acute.

Another concomitant problem, however, is that India has many ‘quack’ doctors who ‘practice medicine’ on their own accord, without sound or even basic knowledge about health and health problems. The shortage of doctors has been fulfilled by these imitators who pose a risk to public health.

In recent years, medical professionals and policy-makers have deliberated about a way out of this dilemma. The Indian Medical Association has an anti-quackery wing in its divisions to deal with complaints of such kind, but reports suggest that as many as a million quacks may be practicing in India, unhindered by the law and frequented by the people due to the lack of alternatives.

Enforcing the law and stopping quacks is one way, but some have argued that training and utilising quacks as healthcare providers is probably another possible solution. Akin to the ASHA model now working in Indian villages, some wonder if this can be a possibility.

West Bengal's trial run

Recently, in 2016, the government of West Bengal, which was struggling to send enough doctors to the villages, rolled out the idea of a certificate course for quacks in basic medicine, on the ethics of medical practice and legalities so that they could fill this gap to some extent. The only conditions that they were to follow were to provide only certain forms of care, refer the cases to doctors in the event of identified red-flag signs which needed professional attention, and most importantly, not use the title doctors anywhere in their work.

The problem was quite serious in West Bengal, where nearly 1.7 lakh quacks are reported to be active state-wide. The government proposed that they be called “informal health care providers” after they complete their six-month training. The training module for this project was based on a pilot project from 2013. There are some red-flag signs they have been taught to identify.

Quacks selected for the programme are trained to identify when to send a patient to a doctor and what to do when someone requires immediate assistance. They are also trained of the consequences should they misuse their positions and prescribe drugs which they are not supposed to prescribe. The minimum qualification required of a candidate for training as an informal health care provider is higher secondary or equivalent.

This idea has found support from some unlikely quarters, with noted people such as Nobel laureate economist Amartya Sen admitting that training of quacks could be a potential strategy to mitigate the shortage of health care providers in the rural areas of India. He however, stressed the need for it being regulated and that the candidate selection be stringent to avoid misuse of the education and liberty provided to treat patients.

The evidence for utilising "quacks"

A study published in the journal Science concluded that in rural India, where 75% of primary care visits were to informal providers, training them could provide a short-term strategy to deal with rural doctor shortage.

The finding was undoubtedly controversial since this is a strategy that many states have toyed with and then abandoned in the face of stiff resistance from trained MBBS doctors and their associations. The study set in West Bengal compared the care provided by trained informal providers with that provided by regular MBBS doctors and found that with training, correct case management by the informal providers improved.

Abhijit Banerjee, a prominent scientist at Jameel Poverty Action Lab at MIT, noted that the introduction of ASHAs and ANMs in rural areas had already begun this trend, although in the case of ANMs, the professionals are qualified and certified nurses and hence not in a similar category to an unqualified quack. However, Banerjee points out that the need of the hour was to improve healthcare and training quacks within boundaries could be a potential solution to deal with the healthcare crisis, especially until the debate about rural postings, the grave lack of infrastructure and the unwillingness of doctors to practice in rural areas is addressed at least to some extent.

The issues with utilising "quacks"

Needless to say, this is not a move or policy that can be rolled out without meaningful debate. As mentioned above, many states have toyed with the idea and abandoned them, and concerns from the medical fraternity are not unwarranted.

In a scenario where prescription medications are freely available and there are few regulations on quacks in rural areas, doctors worry how these quacks will be regulated. If the government did not have the resources and ability to send and sustain doctors or healthcare providers in rural areas, how will it ensure that the quacks sent in rural areas after training do not misuse their “qualifications” or use the title of “doctor” anyway?

Most importantly, since doctors have formal organisations, qualifications and licenses, it is easier to track and regulate the trade of medicine and misdeeds have consequences. How will this be ensured in case of trained quacks, who can easily shift and set up shop at other locations without informing anyone or with no regulatory body to check and monitor their movements.

Across the world, concepts like barefoot doctors and village health workers have been implemented by governments to meet the demands of healthcare where doctors cannot always reach. However, it is indeed a tall order to take a batch of people who were illegally dispensing medications and ‘treating’ patients, training them and hoping they will abide by the rules set for them. Experts argue that this would be a safer idea if it was introduced in a well-regulated framework, which no government implementing such a program has introduced as yet.