Last month, the Telangana government announced that it will go ahead with the training of ‘registered medical practitioners/private medical practitioners’ under the Community Para Medic Training program at a cost of Rs. 4.32 crore as proposed by the erstwhile Andhra Pradesh government.Registered medical practitioners (RMPs) are medical practitioners who are not qualified doctors, but have been trained in basic medical practices, and are registered with the government. The programme to impart para-medical training to RMPs, presumably working in private, is to improve their skills and utilize the work force in the health system. The will be trained in primary treatment, emergency treatments and treat acute minor ailments. The government order, a copy of which is available with TNM, can be read here.Several doctors and the Medical Council of India however are not very happy with the move, calling it one which will dilute the quality of medical profession in the state. Several doctors also call these private RMPs as ‘quacks’, a term used to describe fraudulent doctors. Following the furore, the government changed its programme and said it will only train ‘rural medical practitioners’, RMPs who are only in rural areas. Understandably, there is a considerable confusion over the terminology, reason why doctors call for such medical practitioners to be called ‘unqualified medical practitioners’. The Indian Medical Association takes quackery very seriously and also has a wing dedicated to fighting it. Doctors believe that if quacks are allowed to treat patients with little training, then the quality of medical practice will reduce.The controversy, aside from opening up the insecurity of qualified doctors in the public domain, is a good opportunity to look at the quality of qualified doctors and quacks in India. And research shows that the situation is more complicated than just qualified doctors – good, quacks – bad perception.There is a severe shortage of qualified doctors in India, and often, it is the quacks that fill in for them. Qualified government doctors are known to fall short in living up to their duties, leaving many at the mercy of the quacks.A study by a team of researchers from the World Bank shows that MBBS doctors were no better than quacks in detecting a disease based on simple clinical symptoms, and in some cases were actually better.There is a standard checklist as per global health norms that doctors are to follow when approached by a patient, which a significantly large number of trained doctors failed to do while quacks were better.Half of these quacks did not even complete secondary education. Many launched their own health care practice after being doctor's assistant for several years, a report in Deccan Herald adds.Another discussion paper on Private Health Care for the Poor suggests that quacks "outnumber qualified doctors by at least 10 to 1 and, therefore, by virtue of their numbers, villagers often have more faith in the healing capabilities of such quacks than they do in medical doctors."But quacks may not be to blame completely for this. Another study which talks about the 'Medical Worker absence in India' talks about how many qualified doctors abandon their government clinic duties in rural villages, due to various reasons, leaving the villager to turn towards quacks. While doctors have cried foul with many reports of quacks even driving the registered practitioners out of the village with their influence, research suggests that the doctor’s own records are not clean.A suggestion given by the discussion paper is the franchising or accreditation of quacks. "They are currently unregulated. Although their operations are illegal, it is impossible to shut them down. An alternative method of improving quality is to accredit those who go through basic training which could, at the very least, could cover safe needle protocols," it adds. This is exactly what the Telangana government is trying to do.With inputs from Nitin B