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.

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Bibliographic Details
Main Authors: La Forgia, Gerard, Raha, Shomikho, Shaik, Shabbeer, Maheshwari, Sunil Kumar, Ali, Rabia
Language:English
en_US
Published: World Bank, Washington, DC 2014-06
Subjects: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,
Online Access:http://documents.worldbank.org/curated/en/2014/06/19737148/parallel-systems-human-resource-management-indias-public-health-services-view-front-lines
https://hdl.handle.net/10986/19065
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