Improving the Quality of Private Sector Health Care in West Bengal

NCT02291575 | Completed

• 1 other identifier: RHCPWestBengal
• Study Type: interventional
• Target: 304
• Locations: 0 countries
• Sites: N/A

Brief Summary

The rural healthcare market in much of the developing world is composed largely of informal private providers. These private providers often have little to no certifiable medical training. Recent studies in India using medical vignettes (or hypothetical medical situations) to measure clinical competence and direct observations of doctor-patient interactions to measure clinical practice highlight the poor quality of care that most patients receive-a problem that is clearly relevant beyond India and affects most low-income countries worldwide. For instance:

1. 1.In rural India, standardized patients presenting with chest pain and (on further questioning) radiating pain in the arm are (correctly) diagnosed with a heart attack in less than 25 percent of cases.
2. 2.Across 8 low and middle-income countries, health care providers completed the four necessary vital statistics for new patients in less than 4 percent of interactions: health care providers in the public sectors of many developing countries routinely spend less than 1 minute per patient.

Conditions

Myocardial Infarction; Diarrhea (Dysentery); Asthma

Outcome Measures

Primary Outcomes (1)

• Clinical Practice

  Clinical Practice will be assessed in two ways. First, we will send Standardized Patients, or trained professionals who present with a pre-developed set of symptoms (of one of the three conditions specified) to a provider without the provider's knowledge that he/she is acting. Second, the evaluating team will sit in the providers' clinics after the completion of the intervention, observing provider-patient interactions for a full day. Information will be obtained for each provider-patient interaction on (a) consultation length, (b) history taking, (c) examinations performed, (d) information given to the patient, (e) medicines dispensed/prescribed and (f) prices charged.

  Endline (3-4 months after completion of intervention)

Secondary Outcomes (2)

• Clinical Competence

  Endline (3-4 months after completion of intervention)

• Clinical prices and caseload

  Endline (3-4 months after completion of intervention)

Study Arms (2)

Training

EXPERIMENTAL

Of the 304 participants in the study, half will be randomized into the treatment arm in which they will receive training from the Liver Foundation.The objective of the Liver Foundation's training program will be capacity building through information in health sciences, training in referral techniques during emergencies, and maternal and child health care priorities in rural areas. The training will be in the form of two three-hour classes per week and will continue for nine months, with three mid-term exams administered every three. During this time, the evaluation team will only collect the rosters of the attendees of the training classes and conduct sporadic random visits to the sessions to gain a better sense of the training methods and attendance rates.

Other: Training

Control

ACTIVE COMPARATOR

Half of the sample will be randomized into the control group, for whom there will be no training. They will be phased into training the following year. For the current year, the control group will experience no difference in their routine, aside from some (infrequent) opportunities to participate in other public health activities as provided by the Liver Foundation to any provider involved in their various programs.

Other: Control

Interventions

Training OTHER

(please see Arm Description)

Training

Control OTHER

This group will not receive any training from the Liver Foundation; they will simply be evaluated at baseline and endline.

Control

Eligibility Criteria

• Age: 18 Years - 62 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• must be a private rural healthcare practitioner in West Bengal

You may not qualify if:

• cannot live outside of three specified districts of West Bengal

Sponsors & Collaborators

• Abdul Latif Jameel Poverty Action Lab: lead
• National Rural Health Mission, Government of West Bengal, India: collaborator
• Liver Foundation, West Bengal: collaborator
• World Bank: collaborator

MeSH Terms

Conditions

Myocardial Infarction; Diarrhea; Dysentery; Asthma

Condition Hierarchy (Ancestors)

Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Infarction; Ischemia; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Necrosis; Signs and Symptoms, Digestive; Signs and Symptoms; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases

Study Officials

• Jishnu Das, PhD

  World Bank

  PRINCIPAL INVESTIGATOR

• Abhijit Banerjee, PhD

  Massachusetts Institute of Technology

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MIT Professor of Economics

Study Record Dates

• First Submitted: January 24, 2014
• First Posted: November 14, 2014
• Study Start: October 1, 2012
• Primary Completion: May 1, 2014
• Study Completion: May 1, 2015
• Last Updated: June 28, 2017

Record last verified: 2017-06