Governance of communicable disease control services : a case study and lessons from India

The authors study the impact of governance and administrative factors on communicable disease prevention in the Indian state of Karnataka using survey data from administrators, frontline workers, and elected local representatives. They identify a number of key constraints to the effective management of disease control in India, in misaligned incentives, and the institutional arrangements for service delivery. The authors discuss these under five headings: administrative issues; human resource management; horizontal coordination; decentralization, community involvement, and public accountability; and implementation of public health laws and regulations. They find that India's public health system is configured to be highly effective at top-down reactive work, such as bringing disease outbreaks under control, but not for the more routine collaborations required for proactive disease prevention. The authors conclude with policy recommendations that take into account the complexity of India's system of public administration and the need for simple reforms that can be easily implemented.Health Monitoring&Evaluation,Health Systems Development&Reform,Agricultural Knowledge&Information Systems,Public Health Promotion,Disease Control&Prevention,Health Systems Development&Reform,Health Monitoring&Evaluation,National Governance,Agricultural Knowledge&Information Systems,Health Economics&Finance

Maternal Health Situation in India: A Case Study

Maternal Health Services are one of the basic health services to be provided by nay government health system as pregnant women are one of the most vulnerable victims of dysfunctional health system, India, in spite of rapid economic progress is still farm away from the goal of lowering maternal mortality to less than 100 per 100,000 live births. It still accounts for 25.7% maternal deaths. The maternal mortality in India varies across the states. Geographical vastness and socio-cultural diversity make implementation of health sector reforms a difficult task. The chapter analyses the trends in maternal mortality and various maternal health programs implemented over the years including the maternal health care delivery system at various levels including the recent innovative strategies. It also identifies the reasons for limited success in maternal health and suggests measures to improve the current maternal health situation. It recommends improvement in maternal death reporting, evidence based, focused, long term strategy along with effective monitoring of implementation for improving Maternal Health situation. It also stress the need for regulation of private sector and proper Public Private Partnership (PPP) policy together with a strong political will for improving Maternal Health.

IIMA in HealthCare Management: Abstract of Publications (2000-2010)

The Indian Institute of Management, Ahmedabad (IIMA), was established in 1961 as an autonomous institution by the Government of India in collaboration with the Government of Gujarat and Indian industry. IIMA’s involvement in the health sector started with the establishment of the Public Systems Group in 1975. In the initial period, our research focused on the management of primary healthcare services and family planning. We expanded our research activities to include the management of secondary healthcare services in the 80s and to tertiary healthcare services in the 90s. Currently our research interests focus on the governance and management issues in the areas on Rural Health, Urban Health, Public Health and Hospital Management. In June 2004, IIMA Board approved the setting up of a Centre for Management Health Services (CMHS) in recognition of IIMA’s contributions to the health sector in the past and the felt need to strengthen the management of health sector in the context of socio-economic developments of our country. The overall objectives of CMHS are to address the managerial challenges in the delivery of health services to respond to the needs of different segments of our population efficiently and effectively, build institutions of excellence in the health sector, and influence health policies and wider environments. All our research projects are externally funded and we have developed research collaborations with 15-20 international universities in USA, UK, Europe, and Asia. CMHS has also established strong linkages with the Ministry of Health and Family Welfare at the national and state government levels, particularly in the states of Gujarat, Maharashtra, Rajasthan, Madhya Pradesh, Chattisgarh, Orissa, and Bihar. This working paper is a compilation of the abstracts of all our publications in the last 10 years, which include 40 referred journal articles, 54 Working Papers, 19 Chapters in Books and 18 Case Studies.

Evolution of Social Security in the Lap of Public Action: Recounting the Experience of Kerala

This paper is part of a large study on the Social Protection in Rural India and China. In this paper, we attempt at a critical appraisal of the historical development and experience of social security initiatives in Kerala, India. We situate the development experience of Kerala in a conceptual framework of participatory development, which we interpret in a broad context of organization and mobilization of people at specific junctures of historical progress of a society. Thus participatory development, in our view is participation in the progressive process of realization of human rights and thus in development; that is, public action, with an effective public demand and a wiling public supply, conditioned by the legitimate function of the state. It is also attempted to categorize the on-going social security schemes according to the definitional framework of our study, that is, in terms of the definitional division of social security into basic and contingent social security.Social security; Kerala; development; contingency

Examining decentralization and managerial decision making for child immunization program performance in India

Despite widespread adoption of decentralization reforms, the impact of decentralization on health system attributes, such as access to health services, responsiveness to population health needs, and effectiveness in affecting health outcomes, remains unclear. This study examines how decision space, institutional capacities, and accountability mechanisms of the Intensified Mission Indradhanush (IMI) in India relate to measurable performance of the immunization program. Data on decision space and its related dimensions of institutional capacity and accountability were collected by conducting structured interviews with managers based in 24 districts, 61 blocks, and 279 subcenters. Two measures by which to assess performance were selected: (1) proportion reduction in the DTP3 coverage gap (i.e., effectiveness), and (2) total IMI doses delivered per incremental USD spent on program implementation (i.e., efficiency). Descriptive statistics on decision space, institutional capacity, and accountability for IMI managers were generated. Structural equation models (SEM) were specified to detect any potential associations between decision space dimensions and performance measures. The majority of districts and blocks indicated low levels of decision space. Institutional capacity and accountability were similar across areas. Increases in decision space were associated with less progress towards closing the immunization coverage gap in the IMI context. Initiatives to support health workers and managers based on their specific contextual challenges could further improve outcomes of the program. Similar to previous studies, results revealed strong associations between each of the three decentralization dimensions. Health systems should consider the impact that management structures have on the efficiency and effectiveness of health services delivery. Future research could provide greater evidence for directionality of direct and indirect effects, interaction effects, and/or mediators of relationships

Reforming institutions for service delivery : a framework for development assistance with an application to the health, nutrition, and population portfolio

World Development Report 1997: The State in a Changing World (report no. 17300) argued that institutions-the rules of the game that govern production and exchange-shape a country's prospects for sustained market-led growth. The author provides an institutional framework for service delivery, an essential component of state capability. He applies this framework to an evaluation of Bank support for service delivery in the health, nutrition, and population sector. He argues for greater institutional pluralism in the ways the World Bank does business in infrastructure, rural, and social sectors, but cautions against making efficient service delivery an issue of"state versus market."The Bank and its clients face the challenge of fitting menus of"better practice"delivery options to maps of institutional reality. In the health, nutrition, and population sector, the Bank should (1) unbundle and categorize essential health and clinical services according to goods characteristics and (2) integrate country knowledge into operations through upstream assessments of state, political, and social institutions. Overall, the Bank has made progress toward a"goods characteristics"approach, particularly in infrastructure and some rural services-but it has lagged in the social sectors, where support remains largely technocratic. Cross-sector comparisons reveal four generations of support for service delivery. First-generation support focused mainly on physical implementation of projects. Second-generation interventions, which characterized most social service interventions, focused on improving the financial and organizational viability of implementing agencies through technical assistance. Third-generation support was marked by significant unbundling of service delivery activities and clearer links to goods characteristics. In irrigation (1982-94), telecommunications (1980s-present), and transport (1990s), the one-size-fits-all monopoly model gave way to a range of options based on greater private sector and citizen participation in delivery. These included leases, concessions, outsourcing, and contracting as well as building, operating, transfer, and turnover schemes. Fourth-generation interventions are works-in-progress and represent efforts to develop new governance arrangements that systematically combine competition, voice, and hierarchy in the design, delivery, and monitoring of Bank projects. The Bank has a poor track record building country knowledge of institutional endowments that affect service delivery. The author identifies concepts and tools valuable for sector specialists'operations.Enterprise Development&Reform,Public Health Promotion,Health Economics&Finance,Decentralization,Health Monitoring&Evaluation,Governance Indicators,Poverty Assessment,Environmental Economics&Policies,Health Monitoring&Evaluation,Health Economics&Finance

The World Bank and children : a review of activities

This paper reviews Bank interventions that supported the welfare of children in the last decade. Though the Bank has always addressed children's development, and protection through its focus of broader economic development, and social protection, it has recently intensified its efforts to directly address children's issues in the context of a broader international effort to improve the general welfare of children and, more specifically, to reduce child labor. This paper focuses on Human Development projects with an objective relating to children, or that are expected to have an indirect, but non-trivial impact on children. In the last decade (FY1990-2000), the Bank financed close to 635 Human Development projects, of which 302 projects, fully or partially supported child welfare, development and protection - and the focus of these interventions is discussed in this paper.Street Children,Health Monitoring&Evaluation,Primary Education,Children and Youth,Youth and Governance

India's public health system - how well does it function at the National level?

India has relatively poor health outcomes, despite having a well-developed administrative system, good technical skills in many fields, and an extensive network of public health institutions for research, training, and diagnostics. This suggests that the health system may be misdirecting its efforts, or may be poorly designed. To explore this, the authors use instruments developed to assess the performance of public health systems in the United States and Latin America based on the framework of the Essential Public Health Functions, identified as the basic functions that an effective public health system must fulfill. The authors focus on the federal level in India, using data obtained from senior health officials in the central government. The data indicate that the reported strengths of the system lie in having the capacity to carry out most of the public health functions. Its reported weaknesses lie in three broad areas. First, it has overlooked some fundamental public health functions such as public health regulations and their enforcement. Second, deep management flaws hinder effective use of resources-including inadequate focus on evaluation, on assessing quality of services, on dissemination and use of information, and on openness to learning and innovation. Resources could also be much better usedwith small changes, such as the use of incentives and challenge funds, and greater flexibility to reassign resources as priorities and needs change. Third, the central government functions too much in isolation and needs to work more closely with other key actors, especially with sub-national governments, as well as with the private sector and with communities. The authors conclude that with some reassessment of priorities and better management practices, health outcomes could be substantially improved.Public Health Promotion,Agricultural Knowledge&Information Systems,Health Monitoring&Evaluation,Health Systems Development&Reform,Disease Control&Prevention,Agricultural Knowledge&Information Systems,Health Systems Development&Reform,Health Economics&Finance,Housing&Human Habitats,Health Monitoring&Evaluation