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

La Forgia, Gerard ; Raha, Shomikho ; Shaik, Shabbeer ; Maheshwari, Sunil Kumar ; Ali, Rabia

World Bank, Washington, DC

关键词: ABILITY TO PAY;    ACCOUNTABILITIES;    ACCOUNTABILITY;    ACCOUNTABILITY MECHANISMS;    AGED;   

DOI  :  10.1596/1813-9450-6953
RP-ID  :  WPS6953

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

There is building evidence in India thatthe delivery of health services suffers from an actualshortfall in trained health professionals, but also fromunsatisfactory results of existing service providers workingin the public and private sectors. This study focusses onthe public sector and examines de facto institutional andgovernance arrangements that may give rise towell-documented provider behaviors such as absenteeism,which can adversely affect service delivery processes andoutcomes. The paper considers four human resource managementsubsystems: postings, transfers, promotions, anddisciplinary practices. The four subsystems are analyzedfrom the perspective of front line workers, that is,physicians working in rural health care facilities operatedby two state governments. Physicians were sampled in onepost-reform state that has instituted human resourcemanagement reforms and one pre-reform state that has not.The findings are based on quantitative and qualitativemeasurement. The results show that formal rules areundermined by a parallel modus operandi in which desirableposts are often determined by political connections and sidepayments. The evidence suggests an institutional environmentin which formal rules of accountability are trumped by aparallel set of accountabilities. These systems appear soentrenched that reforms have borne no significant effect.