Medical Pluralism and Health Care for the Poor

The existence of medical pluralism has often been understood in terms of cultural differences in the understanding of health and disease, or as predominance of folk models of disease versus biomedical models in the functioning of health care for underserved populations. From the policy perspective, the presence of a large number of providers in rural and urban areas who are either trained in alternate systems of medicine or have no training except garnered through experience of working as paramedical staff or as informal apprenticeship but who have the status of Rural Medical Practitioners (RMPSs) is seen as a major impediment to rational health care delivery. Yet, the issues are much more complex and regrettably, there is little curiosity on how health care institutions actually function in both public and private sectors. My aim is to open up some of these issues for discussion by looking at the legal framework within which the right to practice is negotiated and the structure of markets,within which health care providers of different kind strive to sustain their medical practice. What implications do these institutional factors have for the character of health care for the urban and rural poor?