Parallel Systems and Human Resource Management in India's Public Health Services : A View from the Front Lines
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.
| Summary: | 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. |
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