Aditya Bandopadhyay has treated the sick for more than twenty years. He works in the village of Salbadra, in the state of West Bengal, India. He has no degree in medicine.

Bandopadhyay was trained in the rudiments of clinical medicine by a homeopath who also happened to practise modern medicine on the side. Bandopadhyay charges every patient just 10 rupees (15 US cents) per visit, notching it up to 20 rupees for house calls. His arsenal includes antibiotics, intravenous saline and chloroquine phosphate for the viral fevers, dysentery and malaria common in the region. But he doesn’t always give his patients medicines; sometimes he just advises them on personal cleanliness. “Tribal people are not very hygienic,” Bandopadhyay says. So he teaches them how to purify water, sprinkle DDT during outbreaks of mosquito-borne disease and use clean sanitary towels during menstruation. “If they come to my chamber, I first give them a dose of hygiene, and then give them a dose of medicine,” he smiles.

Bandopadhyay is a rural medical practitioner, one of an estimated 2.5 million in India who practise medicine without formal training. Among his ilk are people who have worked as assistants to doctors, those who inherited the use of traditional systems of medicine such as Ayurveda and homeopathy from their parents, and graduate lab technicians who switched to healthcare. None of them are doctors by any definition. They are entrepreneurs who have picked up bits and pieces of medicine through informal apprenticeships and built up large practices on their own. Or, in the words of the Indian Medical Association, they are ‘quacks’.

Yet their popularity remains steadfast in their communities. They fill a void in India’s healthcare system that cannot be ignored. And rather than mocking, berating and clamping down on them, at least one organisation is planning to harness them.

For the past couple of months, Bandopadhyay has attended a training programme that may transform the way he goes about his work. It teaches rural practitioners the basics of medicine, from human anatomy to pharmacology, giving them the theoretical knowledge that they lack. Run by the West Bengal-based nongovernmental organisation Liver Foundation, it aims to equip people like Bandopadhyay with the skills to treat acute cases of common illnesses, and, crucially, help them judge when their patients need to see real doctors.

When he graduates, in about seven months’ time, Bandopadhyay will receive a title showing his new paramedic status: Rural Healthcare Provider. But there are also two forfeits. He will have to stop prescribing most Schedule H and Schedule X drugs, medicines that only doctors are allowed to prescribe in India. While he will be allowed limited use of a few antibiotics, such as amoxicillin and doxycycline, in life-threatening conditions, stronger antibiotics such as ceftriaxone will be out of his reach. He will also have to drop the prefix ‘Dr’ from his name, a title currently enjoyed by many rural practitioners. In effect, Liver Foundation’s controversial programme will demote its students, from self-styled and self-taught doctors to health workers who can only treat the simplest of illnesses.

The idea of training rural medical practitioners ignites acrimonious debate in India. On one side are the Indian doctors, and more importantly the associations that represent them, such as the Indian Medical Association. The Association’s official stand is that training such ‘quacks’ is tantamount to legitimising them. It says rural practitioners and their half-baked medical training have caused enormous harm to patients and public health as a whole. The blame for many ills – whether irrational prescriptions of antibiotics, botched surgeries or corrupt practices, such as demanding bribes from qualified doctors to refer patients to them – is laid squarely at the doors of these self-styled doctors. According to Gurinder Singh Grewal, president of the Punjab Medical Council, the state’s hepatitis C epidemic is down to the unhygienic practices of ‘quacks’. “This is courtesy of the usage of bad needles. Blood that is not tested is transfused to people in remote areas,” he says. But others believe that training these rural practitioners is the only way out of India’s healthcare woes.

Fifty-six-year-old Abhijit Chowdhury, professor of hepatology at Kolkata’s Institute of Post Graduate Medical Education and Research and a member of Liver Foundation, is one of the biggest champions of this idea. Chowdhury insists that rural medical practitioners have delivered essential healthcare to patients in remote parts of India, which qualified doctors have abandoned in pursuit of high-paying urban jobs. “On the other hand, there is this group of people, untrained and unemployed before they got into this profession. But, in the dead of the night, they are by the side of the people of the village when they are in trouble.”

Since India’s independence in 1947, its government has tended to overlook rural practitioners. They are illegal, but continue to exist and thrive. State medical councils regularly organise drives to round up ‘quacks’ and file complaints against them. But the police rarely take action, and the sheer numbers of these practitioners ensure they won’t disappear anytime soon. Then there’s the biggest reason of all for their continued survival – rural India doesn’t have enough doctors.