Health Care Delivery

Parallel Systems and Human Resource Management in India's Public Health Services

Increasingly, evidence in India suggests that the delivery of health services suffers from not only a shortfall in trained health professionals, but also from unsatisfactory performance of existing service providers working in the public and private sectors. This study focuses 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 frontline workers, that is, physicians working in rural healthcare facilities operated by two state governments. Physicians were sampled in one state that has instituted human resource management reforms and one state that has not.

The findings are based on quantitative and qualitative measurements. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often obtained through political connections and side payments rather than merit. 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.


This working paper was co-authored by Gerard La Forgia, Shomikho Raha, Shabbeer Shaik, Sunil Kumar Maheshwari, and Rabia Ali. 




Governance in Health Care Delivery: Raising Performance

This 2009 paper argues that good governance is central to raising performance in health care delivery. It provides a definition for good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. The paper was co-authored by Maureen Lewis and Gunilla Pettersson and published as: Governance in Health Care Delivery: Raising Performance, World Bank Policy Research Working Paper Number 5074. 


Patient Flow Measurement: Definitions, Application and Relevance for LMICs

This briefing note summarizes the concepts, approaches, and benefits of patient flow in the US as a backdrop to exploring the use and relevance of patient flow analysis (PFA) in health care delivery across low- and middle-income countries (LMICs). It is meant to provide some basic understanding of PFA, its potential relevance in LMICs and the possible need for alternative metrics for measuring management in those settings.