Mapping Global Voices for Empowering Informal Healthcare Providers to Build a Sustainable Community-Based Primary Healthcare Model in Low- and Middle-Income Countries (LMICs)

Document Type : Viewpoint

Authors

1 Council for Social Development, New Delhi, India

2 Jawaharlal Nehru University, New Delhi, India

Keywords


Introduction

 

Informal healthcare providers (IHPs) have provided primary healthcare services to millions of rural people in low- and middle-income countries (LMICs).1 They are popularly known by several names, such as rural unqualified health practitioners (RUHPs), often called IHPs, village doctors, unqualified practitioners, non-trained allopathy medicine providers, unlicensed providers, non‐formal providers, non-degree health providers, and quacks across various LMICs.1 ...(Read more...)

  1. Debsarma D. Exploring the strategies for upgrading the rural unqualified health practitioners in West Bengal, India: a knowledge, attitude and practices assessment-based approach. Health Policy Open. 2022;3:100083. doi:1016/j.hpopen.2022.100083
  2. Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370(9605):2158-2163. doi:1016/s0140-6736(07)60785-5
  3. Punjab Health Commission. PHC Anti-Quackery Strategy. 2013.
  4. Debsarma D, Choudhary BK. Exploring the socio-ecological factors of healthcare-seeking behaviour among patients/people from Rural Unqualified Health Providers in the rural settings in West Bengal, India. SSM Health Syst. 2025;4:100046. doi:1016/j.ssmhs.2024.100046
  5. Gautham M, Binnendijk E, Koren R, Dror DM. 'First we go to the small doctor': first contact for curative health care sought by rural communities in Andhra Pradesh & Orissa, India. Indian J Med Res. 2011;134(5):627-638. doi:4103/0971-5916.90987
  6. Thapa P, Narasimhan P, Beek K, et al. Unlocking the potential of informal healthcare providers in tuberculosis care: insights from India. BMJ Glob Health. 2024;9(2):e015212. doi:1136/bmjgh-2024-015212
  7. Ahmed SM, Hossain MA. Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: implications for the HRH problem. Health Policy. 2007;84(2-3):332-343. doi:1016/j.healthpol.2007.05.011
  8. Oyeyemi AS, Oladepo O, Adeyemi AO, Titiloye MA, Burnett SM, Apera I. The potential role of patent and proprietary medicine vendors' associations in improving the quality of services in Nigeria's drug shops. BMC Health Serv Res. 2020;20(1):567. doi:1186/s12913-020-05379-z
  9. Shah NM, Brieger WR, Peters DH. Can interventions improve health services from informal private providers in low and middle-income countries?: a comprehensive review of the literature. Health Policy Plan. 2011;26(4):275-287. doi:1093/heapol/czq074
  10. Das J, Chowdhury A, Hussam R, Banerjee AV. The impact of training informal health care providers in India: a randomized controlled trial. Science. 2016;354(6308):aaf7384. doi:1126/science.aaf7384
  11. Kumah E. The informal healthcare providers and universal health coverage in low and middle-income countries. Global Health. 2022;18(1):45. doi:1186/s12992-022-00839-z
  12. Coveney L, Musoke D, Russo G. Do private health providers help achieve universal health coverage? A scoping review of the evidence from low-income countries. Health Policy Plan. 2023;38(9):1050-1063. doi:1093/heapol/czad075
  13. Chukwuocha UM, Iwuoha GN, Ashinze OF, et al. Drug shop intervention to enhance knowledge, attitude, and practices of patent medicine vendors for the control of COVID-19 in Southeastern Nigeria. Am J Trop Med Hyg. 2021;105(2):387-394. doi:4269/ajtmh.20-1549
  14. Christian BN, Christian NG, Keshinro MI, Olutade-Babatunde O. How to build bridges for universal health coverage in Nigeria by linking formal and informal health providers. BMJ Glob Health. 2023;8(11):e014165. doi:1136/bmjgh-2023-014165
  15. Sieverding M, Beyeler N. Integrating informal providers into a people-centered health systems approach: qualitative evidence from local health systems in rural Nigeria. BMC Health Serv Res. 2016;16(1):526. doi:1186/s12913-016-1780-0
  16. Ponticiello M, Mwanga-Amumpaire J, Nansera D, King R, Sundararajan R. Could use of informal healthcare providers increase uptake of HIV testing? Qualitative results from southwestern Uganda. Lancet Glob Health. 2021;9:S25. doi:1016/s2214-109x(21)00133-9
  17. Tavrow P, Shabahang J, Makama S. Vendor-to-vendor education to improve malaria treatment by private drug outlets in Bungoma district, Kenya. Malar J. 2003;2:10. doi:1186/1475-2875-2-10
  18. Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G. Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved? Am J Trop Med Hyg. 2007;77(6 Suppl):203-218.
  19. Goodman CA, Mutemi WM, Baya EK, Willetts A, Marsh V. The cost-effectiveness of improving malaria home management: shopkeeper training in rural Kenya. Health Policy Plan. 2006;21(4):275-288. doi:1093/heapol/czl011
  20. Brieger W, Unwin A, Greer G, Meek S. Interventions to Improve the Role of Medicine Sellers in Malaria Case Management for Children in Africa. London, UK: the Malaria Consortium and BASICS for the United States Agency for International Development; 2005.
  21. Chalker J, Chuc NT, Falkenberg T, Tomson G. Private pharmacies in Hanoi, Vietnam: a randomized trial of a 2-year multi-component intervention on knowledge and stated practice regarding ARI, STD and antibiotic/steroid requests. Trop Med Int Health. 2002;7(9):803-810. doi:1046/j.1365-3156.2002.00934.x
  22. Babar ZU. Ten recommendations to improve pharmacy practice in low and middle-income countries (LMICs). J Pharm Policy Pract. 2021;14(1):6. doi:1186/s40545-020-00288-2
  23. Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D. Correction: what is the role of informal healthcare providers in developing countries? A systematic review. PLoS One. 2013;8(9):10.1371/annotation/93bc7847-5c4e-4b66-8923-500aa4fa4da5. doi:1371/annotation/93bc7847-5c4e-4b66-8923-500aa4fa4da5
  24. Sikder SS. Can informal providers be trained to provide good quality care? In: Walker A, Agarwal A, Jain Y, eds. 50 Studies Every Global Health Provider Should Know. Oxford University Press; 2023. doi:1093/med/9780197548721.003.0003
  25. Onwujekwe O, Mbachu C, Onyebueke V, et al. Stakeholders' perspectives and willingness to institutionalize linkages between the formal health system and informal healthcare providers in urban slums in southeast, Nigeria. BMC Health Serv Res. 2022;22(1):583. doi:1186/s12913-022-08005-2

Articles in Press, Corrected Proof
Available Online from 07 April 2025
  • Receive Date: 20 October 2024
  • Revise Date: 18 January 2025
  • Accept Date: 06 April 2025
  • First Publish Date: 07 April 2025