Informal providers - ground realities in SAARC nations: toward better cancer primary care: a narrative review.

Arnie Purushotham*, Prakash Nayak, Kunal Oswal, Conjeevaram Pramesh, Priya Ranganathan, Richard Sullivan, Carlo Caduff, Shailesh Advani, Ishu Kataria, Yogeshwar Kalkonde, Pavitra Mohan, Yogesh Jain

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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SAARC nations are a group of 8 countries with low to medium Human Development Index values. They lack trained human resources in primary healthcare to achieve the WHO stated goal of Universal Health Coverage. An unregulated service sector of informal healthcare providers (IP) has been serving these underserved communities.

To summarise the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socio-economic milieu that sustains their existence.

A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms ‘Informal Health Care Provider’, ‘Primary Health Care’ across databases like Medline (Pubmed), Google Scholar, and Cochrane database of systematic reviews, World Bank, Centre for Global Development , American Economic Review, JSTOR and Web of Science. In addition citation lists from the primary articles, grey literature in English and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC.

IPs across the rural landscape often comprise over 75% of primary caregivers. They provide accessible and affordable, but often substandard quality-of-care. However, their network would be suitable for prompt cancer referrals. Care-delivery and accountability correlates with prevalent standards of formal-healthcare.

Acknowledgement and upskilling of IPs could be a cost-effective bridge toward universal-health-coverage and early cancer diagnosis in SAARC nations while state capacity for training formal healthcare-providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals that form the core of the rural public primary health care system.
Original languageEnglish
JournalJCO global oncology
Publication statusAccepted/In press - 8 Sept 2022


  • SAARC, Informal Provider, primary healthcare, cancer, early diagnosis.


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