Sarah Pinto explores the emergence of so-called ‘informal providers’ of medicine and biomedical care in rural India. These providers are neither ‘formal’ nor ‘informal’, she argues, but instead “operate on the boundaries of legitimacy” (340). These ‘informal providers’ often fill the gaps where legitimate public health institutions have been too weakened to operate, and are informally sanctioned by the state because their operations are not regulated or denounced. These informal providers, Pinto writes, are actually “neither ‘quacks’ nor legitimate doctors”, but typically lay people who have self-trained, or been partially trained via a development scheme. They can “invent roles for themselves as medical authorities and representatives of development” (337) by claiming the authority of development and medical institutions. These claims go uncontested by legitimate institutions, who are aware of their work filling the gaps in communities with severely limited access to good health care.

In policy and development debates about ‘informal providers’ and their clients, though, informal providers are often characterized as rogue actors, both ‘irrational’ and exploitative, and clients are portrayed as uneducated and easily fooled. On the other hand ‘formal’ institutions are understood as modern, cosmopolitan; decidedly rational actors and purveyors of legitimate biomedical knowledge. In this way, what Pinto explains, is that despite on the ground evidence to the otherwise, formal and informal get defined in opposition to each other. Informal providers are “those against whom the educated and rational self is defined” (2004:356). The danger here is that we fail to understand the reasons why informal providers are trusted in the everyday lives of those who seek health care in environments with limited formal options, and likewise the institutional reasons they are propped up by governments and development organisations.

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