Abstracts

#55 Engaging with Informal Health Providers in Uttar Pradesh, India: Exploring Factors Related to Policy and Implementation


Lorine P Pelly, University of Manitoba; Robert Lorway, University of Manitoba; James Blanchard, University of Manitoba; Maryanne Crockett, University of Manitoba


Introduction

In India, large segments of the population use informal providers (IPs) to meet some or all of their healthcare needs. Governments need to engage with IPs but terms of engagement are affected by cultural beliefs, legal frameworks and politics, factors which also drive policy development. This project aims to understand how government policy directs interaction with IPs within the health system and the impact of decision-making at the district level.


Methods

This project was conducted in two districts of Uttar Pradesh (UP), India. National, state and district policies, guidelines and legal decisions that discuss engagement with IPs were reviewed. Additionally, district-level health managers (five per district) were interviewed regarding views on engaging with IPs, experiences in implementing policies pertaining to IPs and the process for health policy decision-making. Thematic analysis was based on the health policy triangle.


Results

Three national-level documents mentioned IPs and the one that defined roles within the health system was out-of-date. The current 3-Year Action Agenda for India (2017-19) and recent state and district documents did not mention IPs. There were nine relevant legal decisions. Most supported the position that IPs are illegal and state health officials must dismantle such practices and pursue legal action. IPs were previously involved in polio, tuberculosis and family planning programs but are not currently. The interviews revealed that district-level health managers have little ability to influence general health policy. While the illegality of IPs is recognized, the government system is unable to absorb the patients currently seen by IPs.


Conclusion

Explicit guidance on engagement with IPs has disappeared from national-level policy documents. Despite previously participating, no current government programs in the study districts include IPs. The district-level health managers felt disempowered for general decision-making which exacerbated tensions among ground realities, lack of policy guidance and the current legal framework regarding IPs.