Parallel Systems and Human Resource Management in India's Public Health Services : A View from the Front Lines
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World Bank, Washington, DC
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There is building evidence in India that
the delivery of health services suffers from an actual
shortfall in trained health professionals, but also from
unsatisfactory results of existing service providers working
in the public and private sectors. This study focusses on
the public sector and examines de facto institutional and
governance arrangements that may give rise to
well-documented provider behaviors such as absenteeism,
which can adversely affect service delivery processes and
outcomes. The paper considers four human resource management
subsystems: postings, transfers, promotions, and
disciplinary practices. The four subsystems are analyzed
from the perspective of front line workers, that is,
physicians working in rural health care facilities operated
by two state governments. Physicians were sampled in one
post-reform state that has instituted human resource
management reforms and one pre-reform state that has not.
The findings are based on quantitative and qualitative
measurement. The results show that formal rules are
undermined by a parallel modus operandi in which desirable
posts are often determined by political connections and side
payments. The evidence suggests an institutional environment
in which formal rules of accountability are trumped by a
parallel set of accountabilities. These systems appear so
entrenched that reforms have borne no significant effect.
Palabras clave
ABILITY TO PAY, ACCOUNTABILITIES, ACCOUNTABILITY, ACCOUNTABILITY MECHANISMS, AGED, ANTI-CORRUPTION, ASSETS, AUDITOR, AUDITORS, BASIC SERVICES, BULLETIN, CAPACITY BUILDING, CITIZEN, CITIZENS, CIVIL SERVANT, CIVIL SERVANTS, CIVIL SOCIETY, COLLUSION, COMMUNITY HEALTH, CONFIDENCE, CORRUPTION, COUNSELING, CRIMINAL, CRIMINAL LAW, DECISION MAKING, DELIVERY OF HEALTH CARE, DELIVERY OF HEALTH SERVICES, DELIVERY SYSTEM, DELIVERY SYSTEMS, DEMOCRACY, DEVELOPING COUNTRIES, DEVELOPMENT POLICY, DISEASES, DOCTORS, ECONOMIC PERSPECTIVES, ECONOMIC POLICIES, ECONOMIC REVIEW, EVALUATION TECHNIQUES, FAMILY WELFARE, FEMALE LITERACY, FINANCIAL RESOURCES, FOCUS GROUP DISCUSSIONS, GOOD GOVERNANCE, GOVERNMENT AGENCIES, GOVERNMENT OFFICIALS, HEALTH AFFAIRS, HEALTH CARE, HEALTH CARE DELIVERY, HEALTH CARE FACILITIES, HEALTH CARE SERVICES, HEALTH CARE SYSTEM, HEALTH CARE UTILIZATION, HEALTH CENTERS, HEALTH CENTRES, HEALTH COMMITTEES, HEALTH DELIVERY, HEALTH DELIVERY SYSTEM, HEALTH FINANCING, HEALTH INFRASTRUCTURE, HEALTH INSURANCE, HEALTH INSURANCE SCHEME, HEALTH INSURANCE SCHEMES, HEALTH OFFICIALS, HEALTH OUTCOMES, HEALTH PLANS, HEALTH PROFESSIONALS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH SERVICES RESEARCH, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEMS, HOSPITAL, HOSPITALS, HOUSEHOLD SURVEYS, HR, HUMAN RESOURCE MANAGEMENT, HUMAN RESOURCES, HUMAN RESOURCES MANAGEMENT, IMMUNIZATION, INCOME, INCOME DISTRIBUTION, INFORMAL SECTOR, INPATIENT CARE, INSURANCE SCHEMES, INTERMEDIARIES, INTERNAL MIGRATION, KICKBACKS, LEADERSHIP, LOCAL COMMUNITY, LOW-INCOME COUNTRIES, MANAGEMENT SYSTEMS, MARITAL STATUS, MEDICAL SCHOOL, MIGRATION, MINISTER, MINISTRIES OF HEALTH, MINISTRY OF HEALTH, MINORITY, MORBIDITY, MORTALITY, NATIONAL HEALTH, NATIONAL HEALTH SYSTEMS, NURSE, NURSES, NURSING, NUTRITION, OUTPATIENT CARE, PATIENT, PATIENT CHOICE, PATIENTS, PATRONAGE, PEDIATRICS, PENSIONS, PHYSICIAN, PHYSICIANS, PLACE OF RESIDENCE, POLICY DISCUSSIONS, POLICY MAKERS, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POLITICAL CHANGE, POLITICAL CORRUPTION, POLITICAL LEADER, POLITICAL LEADERS, POLITICAL PARTIES, POLITICAL SUPPORT, POLITICIAN, POLITICIANS, POLLUTION, POOR HEALTH, POPULAR SUPPORT, PRIMARY CARE, PRIVATE CARE, PRIVATE HEALTH SERVICES, PRIVATE SECTOR, PRIVATE SECTORS, PROBABILITY, PROGRESS, PSYCHOLOGY, PUBLIC ADMINISTRATION, PUBLIC HEALTH, PUBLIC HEALTH CARE, PUBLIC HEALTH SERVICES, PUBLIC HEALTH SYSTEM, PUBLIC HEALTH WORKERS, PUBLIC HOSPITALS, PUBLIC OFFICIALS, PUBLIC OPINION, PUBLIC PROVIDERS, PUBLIC SECTOR, PUBLIC SERVICE, PUBLIC SERVICES, PUBLIC SPENDING, QUALITY CARE, QUALITY OF CARE, QUANTITATIVE RESEARCH, REFORM EFFORT, RESEARCH METHODS, RURAL AREAS, RURAL HEALTH CARE, SANCTIONS, SANITATION, SENSITIVE ISSUES, SENSITIVE TOPICS, SERVICE PROVIDERS, SERVICE PROVISION, SOCIAL DEVELOPMENT, SOCIAL INFRASTRUCTURE, SPOUSE, SPOUSES, STATE GOVERNMENT, STATE GOVERNMENTS, SURGERY, THEFT, TRANSPARENCY, URBAN AREAS, URBAN CENTERS, VICTIMS, WORKERS