Suprakash Roy has been in great demand in his village in Alipurduar district since the first wave of COVID-19 hit West Bengal around this time last year.
Even today, a steady stream of villagers throng his chamber – a small rectangular room cramped with a wooden table, a plastic chair and a wall-mount shelf stacked with assorted medicines.
The verandah in the front serves as a virtual ’emergency ward.’ Saline drips, hooked on a string that also serves as a clothesline, are often administered to patients placed on the floor.
For many people living around Jaldapara National Park in West Bengal’s Alipurduar district, middle-aged Suprakash Roy and his one-man health infrastructure is the first line of defence against the raging pandemic.
From snake bites to COVID, villagers first rush to him for “treatment” of all ailments. “The other day, a man mauled by a tiger came to me for treatment. After dressing his wounds, I referred him to the district hospital,” Roy said with the conviction of a qualified physician, except that he is not.
But, Roy has nothing to be afraid of anymore. He is among the state’s estimated 2,75,000 informal rural health care providers, often dismissed as quacks, fighting the COVID surge in villages where finding even an MBBS doctor is a big deal.
The newly elected state government has now decided to rope them in, in its fight against novel coronavirus in far-flung areas where there is an acute shortage of qualified doctors.
Making the announcement two days back, Chief Minister Mamata Banerjee said these healthcare providers would be given training on handling COVID-19 patients before utilising their services in rural areas.
Accredited Social Health Activists (ASHA) played a crucial role in keeping the COVID-19 at bay in rural areas during the first surge, said a senior health department official, adding that door-to-door surveillance of ASHA workers helped in early detection and treatment.
“Now, in addition to ASHA activists, we have also decided to utilise the services of informal health service providers to plug the shortage of rural doctors,” said the official.
West Bengal has around 1,000 primary health centres, against a requirement of over 3,000, for its nine crore population. The huge gap is filled by these informal practitioners.
A 2016 World Health Organization (WHO) report on the health workforce in India states that a whopping 57.3 per cent of those practising allopathic medicine did not have any medical qualification.
For long, several health experts have advocated the need to formalise the services of these informal practitioners, much like the non-physician clinicians of sub-Saharan African countries.
“These healthcare providers are the first point of contact for patients in villages. Utilising their service in a proper and more formal way will definitely help in fighting the second wave in rural areas,” said physician Abhijit Chowdhury.
Experts believe that considering the lack of availability of trained doctors, training informal healthcare providers can serve as a stopgap measure to improve the situation, particularly in rural areas.
A 2016 study by Chowdhury and others researchers, including Nobel Prize-winning economist Abhijit Banerjee, suggested that “multitopic medical training (to informal health care providers) may offer an effective short-run strategy to improve healthcare provision and complement critical investments in the quality of public care.”
Chowdhury’s Kolkata-based non-profit, ‘Liver Foundation’, has been training these healthcare providers since 2008. Now, even the West Bengal government provides similar training at more than 30 centres.
These health service providers would be given COVID management training by block and sub-divisional hospitals and would be advised on steps to be taken to handle even critical patients.
“They will be provided basic training in batches and will be placed under the guidance of qualified doctors in their respective districts and blocks. We are also preparing a list of dos and dont’s for them,” said the state health department official.
Even during the first surge of COVID last year, these informal health providers were referring people to testing centres for early detection and treatment. This time the government would help them carry out the same job in a more formal way and would make them accountable.