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

36 Pages Posted: 20 Apr 2016

See all articles by Gerard M. La Forgia

Gerard M. La Forgia

World Bank - East Asia and Pacific Region

Shomikho Raha

World Bank - Social Development

Shabbeer Shaik

Center for Good Governance

Sunil Kumar Maheshwari

Indian Institute of Management (IIM), Gujarat

Rabia Ali

World Bank

Date Written: June 1, 2014

Abstract

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.

Keywords: Health Monitoring & Evaluation, Health Systems Development & Reform, Population Policies, Public Sector Corruption & Anticorruption Measures, Health Economics & Finance

Suggested Citation

La Forgia, Gerard M. and Raha, Shomikho and Shaik, Shabbeer and Maheshwari, Sunil Kumar and Ali, Rabia, Parallel Systems and Human Resource Management in India's Public Health Services: A View from the Front Lines (June 1, 2014). World Bank Policy Research Working Paper No. 6953, Available at SSRN: https://ssrn.com/abstract=2460116

Gerard M. La Forgia (Contact Author)

World Bank - East Asia and Pacific Region ( email )

Washington, DC 20433
United States

Shomikho Raha

World Bank - Social Development

United States

Shabbeer Shaik

Center for Good Governance

Hyderabad
India

Sunil Kumar Maheshwari

Indian Institute of Management (IIM), Gujarat

Gujarat
India

Rabia Ali

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

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