Quality of medical advice in low-income countries

Some facts from the article by Das, Jishnu, Jeffrey Hammer, and Kenneth Leonard. 2008. "The Quality of Medical Advice in Low-Income Countries." Journal of Economic Perspectives, 22(2): 93–114:

Doctors in Tanzania complete less than a quarter of the essential checklist for patients with classic symptoms of malaria, a disease that kills 63,000–96,000 Tanzanians each year. A public-sector doctor in India asks one (and only one) question in the average interaction: “What’s wrong with you?” In Paraguay, the amount of time a doctor spends with a patient has nothing to do with the severity of the patient’s illness.

. . . [t]hree years of medical school in Tanzania result in only a 1 percentage point increase in the probability of a correct diagnosis.

[The] usage of health facilities in India—both in a relatively rich urban sample and a relatively poor rural sample—is higher than the U.S. average of 3.15 visits per person per year

The average time spent with patients in Paraguay is similar to that in many high-income rich countries. At over eight minutes per visit, Paraguay ranks higher than Germany and Spain, though lower than the United Kingdom or Belgium. In contrast, consider Delhi. In the average interaction, the doctor sees the patient for 3.8 minutes, asks 3.2 questions, and performs just over one examination procedure.

. . . [c]ommunity meetings “empowered” women to demand better care from their doctors and that consequently there was a large increase in effort and hence the quality of care delivered.

. . . [s]tandard measures of health care quality in low-income countries, based on physical infrastructure and sometimes on availability of certain drugs, are sorely inadequate. The quality of medical advice cannot be “proxied for” by measures of physical infrastructure.