Rural populations, especially in developing countries such as India, are confronted with lack of physical access to good quality outpatient healthcare services. Trained community health workers who are often the first line of healthcare service provision in rural areas have not been very successful in filling this gap because their skills are not trusted, because they cannot prescribe drugs and because of high drop-out rates owing to poor remuneration. This has often meant a reliance on unqualified private healthcare providers and high levels of out of pocket spending on care of low quality.
This paper reports the results of a field experiment in rural Maharashtra (India) to assess the impact of a pre-payment scheme for outpatient visits to community health workers linked by cell phone to a city-based outpatient care clinic staffed by doctors. Community health workers were also able to prescribe and distribute drugs based on online and phone consultation with city-based doctors. Apart from a small base-salary component, they were provided a commission based on the number of pre-payment schemes they were able to sell to households in their village. The project was conducted in collaboration with the Centre for Insurance and Risk Management (Chennai, India) and the Rural Health Division of CARE Hospitals, India.