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

机译：印度公共卫生服务中的并行系统和人力资源管理：从前线看

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摘要

There is building evidence in India that the delivery of health services suffers both from an actual shortfall in trained health professionals and from unsatisfactory results 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 that can adversely affect service delivery processes and outcomes. We analyze four human resource management (HRM) subsystems: postings, transfers, promotions and disciplinary practices from the perspective of front-line workersphysicians working in rural healthcare facilities operated by two state governments. We sampled physicians in one post-reform state that has instituted HRM reforms and one pre-reform state that has not. The findings are based on both quantitative and qualitative measurements. 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. Copyright (c) 2015 John Wiley & Sons, Ltd.
机译：印度有越来越多的证据表明，卫生服务的提供既受到训练有素的卫生专业人员的实际短缺，也受到在公共和私营部门工作的现有服务提供商的令人满意的结果的困扰。这项研究的重点是公共部门，并研究了可能导致提供证据充分的提供者行为（例如旷工）的事实制度和治理安排，这些行为可能会对服务提供过程和结果产生不利影响。我们从在两个州政府运营的农村医疗机构中工作的一线工人医师的角度分析了四个人力资源管理（HRM）子系统：发布，调动，晋升和纪律做法。我们在一种改革后的状态（已进行HRM改革）和一种改革前的状态（尚未进行HRM改革）中对医生进行了抽样调查。这些发现基于定量和定性的测量。结果表明，形式规则受到平行方式的破坏，在这种方式中，理想职位通常由政治联系和附带付款决定。证据表明，制度环境中正式的问责规则被平行的问责制所压倒。这些制度似乎根深蒂固，以至于改革没有产生重大影响。版权所有（c）2015 John Wiley＆Sons，Ltd.

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