Improving the Quality of Private Sector Health Care in West Bengal

The rural healthcare market in much of the developing world, and especially in South Asia, is composed largely of informal private providers. These private providers often have little to no certifiable medical training. Recent studies, using medical vignettes (or hypothetical medical situations) to measure clinical competence and direct observations of doctor-patient interactions to measure clinical practice, highlight the deplorably low standards in rural healthcare. To address such standards, the Liver Foundation in Kolkata, West Bengal over the last two years has been working with private rural health care providers through capacity building activities to improve quality in the private sector. The program consists of multiple-week training to private rural health care providers on the basis of a well-developed curriculum in the district of Birbhum, West Bengal.

This study aims to assess the impact of this training program using a randomized evaluation. We employ medical vignettes, provider diaries, direct observation, and standardized patients to assess how such a training program can effect clinical competence, practice, caseload and case types, and fee structures in the short run. It is worth noting that this study will not be able to capture long run effects, such as general equilibrium price or location changes, on health care for the rural poor.