Primary healthcare system: Sailing under false colors?


‘42% Wrong treatment in Madhya Pradesh (India)’

‘Only 22% correct diagnosis in Delhi (India)’.

Primary Health care system is considered as the “First” level of contact between individual and the health system. It is closest to the people. India spends 4.2 percent GDP on health care. In India and probably other developing countries as well, Primary health care is indispensable as 70% of population lives in rural areas. In India, the funding for Primary health care system has tripled from 100 billion USD in 2005-06 to 304 billion USD in 2011-12.

Recently, I came across a very interesting yet shocking article. A study done by Das et al questioned the Primary health care system of India. In this study, Das and his colleagues trained 22 people to be credible fake patients. They were trained to fake illnesses and symptoms which were subjective and could not be verified objectively. These patients were sent to consult 305 different medical care providers in 2 states of India, Madhya Pradesh and Delhi. The main goal of this study was to access the quality of health care services provided by the medical practitioners.

The conditions chosen by the team were unstable angina, dysentery and asthma as these conditions pose low risk to fake patients from invasive examinations. Moreover, these conditions have established medical protocols and standardized government provided checklists for treatment. The patients were recruited from local communities and were given proper training especially to portray the emotional, physical and psychosocial aspects of these illnesses. They were coached in how to avoid an invasive examination and what to note from the encounter. The medicines given by the Practitioners were saved and their names recorded.

None of the medical practitioners in Madhya Pradesh came to know about these fake patients whereas in Delhi only 1% could spot it. Only one third of the practitioners asked all the essential questions and did the required examinations.

Only one third of the health care providers in Madhya Pradesh were able to give a diagnosis. Only 12% of the diagnoses given by healthcare providers in Madhya Pradesh were completely correct whereas 41% were partially correct.

In Delhi, only 22% were able to diagnose the problem correctly.

Apart from the finding that unqualified providers in both Delhi and Madhya Pradesh asked few questions, did fewer examinations and most of them prescribed wrong treatment; the shocking finding was that providers who were qualified and better equipped also prescribed wrong treatments.

As per this study, the rural residents of Madhya Pradesh and Delhi faced 70% and 55% chances respectively of being prescribed the wrong treatment (at least for these conditions)!! Does that mean these results would be replicable elsewhere in India?  If yes, then what can be done to fix this problem? Is it fair that a significant portion of country’s GDP is wasted in misdiagnosing and mistreating common illnesses?


Das J., Holla A., et al. In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps Health Aff, December 2012 31:12, 2774-2784


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