Informal providers (IPs)—the plethora of independent and largely unregulated health care practitioners— are a vital source of care for many in lower- and middle-income countries, comprising over 50% of health care workers in India and close to 96% in rural Bangladesh, according to some estimates. They are utilized for a wide variety of health interventions and often represent the first point of care for patients, particularly the poor. Although they are heavily utilized, IPs pose a number of challenges. They generally have little formally recognized training and operate outside of the purview of regulatory authority. As a result, the quality of their care is not well known.
Recognizing that IPs are a significant component of the private market, the Center for Health Market Innovations (CHMI) launched a study to explore the characteristics of informal providers and the dynamics of their interaction with the broader health system.
As a starting point, CHMI, in collaboration with the Global Health Group at the University of California, San Francisco (UCSF), carried out a literature review on informal providers to determine the extent of current knowledge on the topic. The literature review—as well as subsequent meetings of a Technical Working Group on Informal Providers convened for this study—identified a need for further research into informal health market dynamics, including additional on-the-ground research in countries where the informal sector plays an important role in health service delivery. A competitive proposal process led to the selection of grantees to carry out fieldwork in Bangladesh, India and Nigeria.
This summary provides an overview of the studies' findings.