Just went through the paper's abstract. The quality of care provided in most PHCs in India is certainly of questionable quality. Indeed, the average time per consult at OPs I have visited is often around a minute or less. That and the resulting poor quality of care is nothing new (cf. recent studies using clinical vignettes by Rao et. al. "Which doctor for rural India?"). In fact, if one sees the kind of records maintained (or not), the diagnoses are often - "headache", "breathing problem" and such. A complex interplay among various factors including the poor HR practices in terms of financial and non-f incentives, working atmosphere, near-nil private sector regulation and many such factors have a role. While I appreciate the approach towards the research and the rigor, the difficulty is in now asking how this can be addressed. Especially considering that the most important (though unfortunately long-term) solution lies in medical education reform and private sector regulation.