Why do quacks function freely in India?

New Delhi: The recent arrest of a man in Uttar Pradesh for allegedly injecting 41 people with the HIV virus from a single infected needle highlights how so-called ‘quacks’ are able to ply their trade freely in India—aided by a dearth of qualified doctors, government apathy to patient safety and the desperation of the poor.

The incident in Uttar Pradesh’s Unnao district paints a grim picture of neglect of healthcare. According to one authoritative study, there are a million unregistered and unqualified medical practitioners in India.

State health workers stumbled upon the medical scandal while conducting a routine screening between April and November 2017, when they found over 24 HIV positive cases in just one tehsil—Bangarmau. An investigation found that Rajendra Kumar, an unqualified medical practitioner or quack, had used a single syringe on poor patients, promising cheap treatment.

Such incidents are not uncommon in India. In a similar incident, in 2011, at least 28 children suffering from thalassemia (a blood disorder) were allegedly infected with HIV in a hospital in Junagadh, Gujarat, following blood transfusion.

The National AIDS Control Organisation (Naco) on Monday sent a team to Unnao to study the situation and submit its report to the central health ministry by the end of this week.

Experts say India is beset by a wide range of problems in healthcare delivery. Overcrowded and underresourced public hospitals and expensive private hospitals often lead poverty-stricken families to turn to quacks. Thus, patient safety is largely compromised in India.

For instance, on needle safety alone—a matter that has been consistently highlighted globally and nationally since the first AIDS cases in the 1980s—India lags behind many other countries.

The World Health Organisation (WHO) has urged all countries including India to switch to the exclusive use of the auto-disable (AD) “smart” syringes that can only be used once. WHO says that the move can eliminate avoidable deaths and infections from reusable syringes and unsafe injection.

Some countries such as Uganda and Tanzania have banned unqualified medical practitioners and private sector from access to disposable syringes. India is yet to adopt this practise on a national scale. However some hospitals—public and private—do use auto-disable syringes.

“This (Unnao cases) could be just the tip of the iceberg as the problem is spread across the country. With more than 40,000 quacks in Delhi alone reusing syringes constitutes one of their main unsafe practices. It is urgently needed to introduce Universal Infection Prevention (UIP) guidelines including urgent deployment of auto disable syringes to limit infections from spreading,” said Rajiv Nath, president, All India Syringes and Needles Manufacturers Association (AISNMA).

“India currently has no tracking of infections or registry via public healthcare from reuse of syringes or needles or needle stick injuries. According to WHO, every $1 spent on injection safety saves $14 in public healthcare,” said Nath.

A 2016 study by the department of health research under the health ministry found that auto-disable syringes cost only Rs1.90 each.

“Bringing in AD syringes is largely a government and policy matter and we don’t have much role in this,” said Alok Saxena, joint secretary, Naco. “We are running several programs for injection safety. But quackery is a major problem. Not only HIV, reusing the syringes can spread Hepatitis B and other infections also. Once our team gives us a detailed report, we will take necessary steps in Unnao case.”

“The disposable syringes are safe but inappropriate use of these syringes certainly has high chances of harm and spread of infection,” said G.N. Singh, drug controller general of India.

A study by Samik Chowdhury for the National Institute of Public Finance and Policy (NIPFP), on urban slums of Delhi, revealed in about 80% of the cases a private doctor was approached for treatment.

“The most appalling finding however is that almost 15% of the ailing sample opted for treatment from an unregistered private practitioner. These are none other than “quacks”, locally known as the “bangali daaktar” who are quite conspicuous within the slums. They attract a lot of patients owing to their location utility and low charges which would be made clear in the following section on expenditure,” the study said.

While there is a huge shortage of doctors, there are over one million ‘quacks’ practising in India, according to the Indian Medical Association (IMA).

According to the National Health Profile 2017, in India there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people.

The shortage of health providers and infrastructure is most acute in rural areas.livemint

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