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Qualitative Health Research
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Barriers of Mistrust: Public and Private Health Sectors' Perceptions of Each Other in Madhya Pradesh, India

Ayesha De Costa

Karolinska Institutet, Stockholm, Sweden, and RD Gardi Medical College, Madhya Pradesh, India

Eva Johansson

Karolinska Institutet, Stockholm, Sweden

Vinod K. Diwan

Karolinska Institutet, Stockholm, Sweden, and RD Gardi Medical College, Madhya Pradesh, India

India has one of the most highly privatized health care systems in the world. The dominant private health sector functions alongside a traditional tiered public health sector. There has been an overall lack of collaboration between the two sectors despite international policy recommendations and local initiatives. It has been postulated that "conflicting perceptions" might contribute to the uncooperative attitude between the two sectors. But there has been little empirical exploration of the existing perceptions that the private and public health sectors have of each other. We explored these perceptions among key stakeholders (who influence the direction of health policy) in the public and private health sectors in the province of Madhya Pradesh, India. The barriers of mistrust, which hinder true dialogue, are complex, and have social, moral, and economic bases. They can be best addressed by necessary structural change before any significant long-term partnership between the two sectors is possible.

Key Words: Asia • ethics • health care, access to • health care professionals • health policy • India • trust

Qualitative Health Research, Vol. 18, No. 6, 756-766 (2008)
DOI: 10.1177/1049732308318504
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