Unfree markets

Socially embedded informal health providers in northern Karnataka, India

Bibliographic Data

ID4597700
AuthorsAsha George (0000-0002-5968-1424, Indian Institute of Management Bangalore, corresponding author), Aditi Iyer (0000-0002-2177-0755, Indian Institute of Management Bangalore)
Year2013
Volume96
Pages297-304
Publication date2013-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2013.01.022
PMID23484865
OpenAlexW2083949684
LanguageEN
Citations received23
References cited24

The dynamics of informal health markets in marginalised regions are relevant to policy discourse in India, but are poorly understood. We examine how informal health markets operate from the viewpoint of informal providers (those without any government-recognised medical degrees, otherwise known as RMPs) by drawing upon data from a household survey in 2002, a provider census in 2004 and ongoing field observations from a research site in Koppal district, Karnataka, India. We find that despite their illegality, RMPs depend on government and private providers for their training and referral networks. Buffeted by unregulated market pressures, RMPs are driven to provide allopathic commodities regardless of need, but can also be circumspect in their practice. Though motivated by profit, their socially embedded practice at community level at times undermines their ability to ensure payment of fees for their services. In addition, RMPs feel that communities can threaten them via violence or malicious rumours, leading them to seek political favour and social protection from village elites and elected representatives. RMPs operate within negotiated quid pro quo bargains that lead to tenuous reciprocity or fragile trust between them and the communities in which they practise. In the context of this 'unfree' market, some RMPs reported being more embedded in health systems, more responsive to communities and more vulnerable to unregulated market pressures than others. Understanding the heterogeneity, nuanced motivations and the embedded social relations that mark informal providers in the health systems, markets and communities they work in, is critical for health system reforms

Business · Economic growth · Economics · Government (linguistics · Political science · Public relations · Reciprocity (cultural anthropology · Sociology · Global Health and Epidemiology · Global Maternal and Child Health · Healthcare Systems and Reforms