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.

Hospital Efficiency: An Empirical Analysis of District and Grant-in-Aid Hospitals in Gujarat

This study focuses on analysing the hospital efficiency of district level government hospitals and grant-in-aid hospitals in Gujarat. The study makes an attempt to provide an overview of the general status of the health care services provided by hospitals in the state of Gujarat in terms of their technical and allocative efficiency. One of the two thrusts behind addressing the issue of efficiency was to take stock of the state of healthcare services (in terms of efficiency) provided by grant-in-aid hospitals and district hospitals in Gujarat. The motivation behind addressing the efficiency issue is to provide empirical analysis of governments policy to provide grants to not-for-profit making institutions which in turn provide hospital care in the state. The study addresses the issue whether grant-in-aid hospitals are relatively more efficient than public hospitals. This comparison between grant-in-aid hospitals and district hospitals in terms of their efficiency has been of interest to many researchers in countries other than India, and no consensus has been reached so far as to which category is more efficient. The relative efficiency of government and not-for-profit sector has been reviewed in this paper. It is expected that the findings of the study would be useful to evaluate this policy and help policy makers to develop benchmarks in providing the grants to such institutions.

Efficiency of Health Care Sector at Sub-State Level in India: A Case of Punjab

In recent years, WHO and other individual researchers have advocated estimation of health system performance through stochastic frontier models. It provides an idealized yardstick to evaluate economic performance of health system. So far attempts in India have remained focused at state level analysis. This paper attempts a sub-state level analysis for an affluent Indian state, namely Punjab, by using stochastic frontier technique. Our results provide pertinent insight into state health system and facilitate health facility planning at the sub-state level. Carried out in two stages of estimation, our results suggest that life expectancy in the Indian state could be enhanced considerably by correcting the factors that are adversely influencing the sub-state level health system efficiency. A higher budgetary allocation for health manpower is recommended by us to improve efficiency in poorly performing districts. This may be supported by policy initiatives outside the health system by empowering women through better education and work participatio

Are incentives everything? payment mechanisms for health care providers in developing countries

This paper assesses the extent to which provider payment mechanisms can help developing countries address their leading health care problems. It first identifies four key problems in the health care systems in developing countries: 1) public facilities, which provide the bulk of secondary and tertiary health care services in most countries, offer services of poor quality; 2) providers cannot be enticed to rural and urban marginal areas, leaving large segments of the population without adequate access to health care; 3) the composition of health services offered and consumed is sub-optimal; and 4) coordination in the delivery of care, including referrals, second opinions, and teamwork, is inadequate. The paper examines each problem in turn and assesses the extent to which changes in provider payments might address it.Health Economics&Finance,Health Systems Development&Reform,Public Health Promotion,Health Monitoring&Evaluation,Early Child and Children's Health,Health Monitoring&Evaluation,HealthEconomics&Finance,Health Systems Development&Reform,Environmental Economics&Policies,Housing&Human Habitats

Population, health, and nutrition : annual operational review for fiscal 1992

Population, health, and nutrition (PHN) lending decreased in fiscal 1992 from the record levels of fiscal 1991, in both the amount and the number of operations. Lending amounted to $961.6 million for 16 projects, compared with$1,567.6 million for 28 projects in fiscal 1991. This temporary dip in PHN lending is attributable largely to pipeline factors. Fiscal 1993 lending is projected to recapture if not exceed the fiscal 1991 level, and projections for fiscal 1993 and fiscal 1995 are for a continued increase in lending volume. PHN projects approved in fiscal 1992 have been responsive to the World Bank's objective of poverty alleviation. Collectively, fiscal 1992 projects cover the essential features of good poverty work but the depth and quality of poverty work varies across projects. Drawing from the good practices observed and lessons recorded in this year's portfolio, the review offers the following suggestions, among others, for strengthening PHN interventions to alleviate poverty: poverty information and monitoring must be accompanied by dissemination and sensitization activities to strengthen national understanding of poverty-related issues and national commitment to resolving them through the proper policy; community involvement in project design and development requires clearly defined and carefully designed institutional and procedural mechanisms, and a concerted effort to make them work; it is essential that PHN sector work identify poor and vulnerable groups and assess their needs and demands for basic health, family planning, and nutrition services; and even the most demand-driven project designs targeted to clearly identified poverty groups require promotional activities to ensure that these groups participate in and benefit from project initiatives. Health lending is now a decade old, and many innovations in PHN lending have emerged only in the past four or five years. This review demonstrates that good practices and new and promising ideas - well worth emulating - are scattered across PHN work. Overall, PHN work is moving in the right direction and the quality of work is generally seen to be improving. Welcome trends (which should be encouraged and reinforced) include serious attention to the poorest, most vulnerable populations, growing consideration of the demand of target groups, and increased attention to monitoring and evaluation of sector performance.Health Monitoring&Evaluation,Health Economics&Finance,Banks&Banking Reform,Poverty Monitoring&Analysis,Urban Services to the Poor

Governance in health care delivery : raising performance

The impacts of health care investments in developing and transition countries are typically measured by inputs and general health outcomes. Missing from the health agenda are measures of performance that reflect whether health systems are meeting their objectives; public resources are being used appropriately; and the priorities of governments are being implemented. This paper suggests that good governance is central to raising performance in health care delivery. Crucial to high performance are standards, information, incentives and accountability. This paper provides a definition of good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. Performance indicators that offer the potential for tracking relative health performance are proposed, and provide the context for the discussion of good governance in health service delivery in the areas of budget and resource management, individual provider performance, health facility performance, informal payments, and corruption perceptions. What we do and do not know about effective solutions to advance good governance and performance in health is presented for each area, drawing on existing research and documented experiences.Health Monitoring&Evaluation,Health Systems Development&Reform,Public Sector Expenditure Policy,Health Economics&Finance,Health Law

Tuberculosis Control in developing countries: A Generalized Community Health Worker Based Model

Tuberculosis is a major health care burden in developing countries. World Health Organization (WHO) has been assisting developing countries through their respective Governments to control this curable disease. The Amsterdam declaration aims to control tuberculosis globally by the year 2005. The TBC project implementation experiences are varied across countries both on cure and detection rates. The government initiatives are complemented by the non government organizations involvement at the operational level. The BRAC model in Bangladesh involves the NGOs in an extensive and cohesive way. This paper documents the BRAC model for TBC in Bangladesh. We introduce the concept of value chain, in the context of TBC. Based on the value chain concept, the logic for the effectiveness of the BRAC model is discussed. An improved version of the Bangladesh delivery model is proposed. We hope the model proposed in this work would draw the attention of policy planners, and help them to control TB in their respective countries.

Implementing a Public Private Partnership Model for Managing Urban Health in Ahmedabad

Governments in many developing countries acknowledge they are facing difficulties in their attempt to meet the basic health needs of their populations. They rely on contracting out to private (for-profit and not-for-profit) organizations as a strategy to meet the needs of underserved populations. For the most part, the public sector chooses to contract out primary healthcare services to the private sector to expand access, increase the availability of medicines and medical supplies, and improve the quality of care. In both urban and rural settings, private for-profit and non-profit health service providers serve both the rich and the poor. Communities often recognize private sector healthcare providers to be more responsive to their healthcare needs and preferences in terms of services available, suitable timings and geographical access etc. Private sector has always played a significant role in the delivery of health services in developing countries. Public-private-partnership (PPP) is an approach under which services are delivered by the private sector, while the responsibility for providing the resources rests with the government. Establishing a PPP requires a legal framework acceptable to all the partners, clarity on the commitment of resources, roles and responsibilities of each partner, as well as accountability to provide a given set of services at a desired level of quality and affordable user charges. Formalizing such an arrangement between partners requires conceptualising a framework for Public Private Partnership (PPP) to manage the delivery of health services. In this paper, we describe the design, development and implementation of a PPP for managing urban health services in Ahmedabad city, Gujarat. Our model has succeeded in bringing together compatible public and private partners to plan and deliver quality healthcare services to meet the community needs of Vasna ward, in Ahmedabad. The new Vasna Urban Health centre was inaugurated on July 23, by the Chief Minister of Guajarat. This new centre now serves about 120 outpatients everyday as against an average of 10 outpatients daily earlier.

Economic security arrangements in the context of population ageing in India

The rapid ageing of India's population, in conjunction with migration out of rural areas and the continued concentration of the working population in the informal sector, has highlighted the need for better economic security arrangements for the elderly. Traditional family ties that have been key to ensuring a modicum of such security are beginning to fray, and increased longevity is making care of the elderly more expensive. As a result, the elderly are at increased risk of being poor or falling into poverty. In parallel with its efforts to address this issue, the Government of India and some of the Indian states have initiated an array of programmes for providing some level of access to health care or health insurance to the great majority of Indians who lack sufficient access. Formal-sector workers have greater social security than those in the informal sector, but they only represent a small share of the workforce. Women are particularly vulnerable to economic insecurity. India's experience offers some lessons for other countries. Although there is space for private initiatives in the social security arena, it is clear that most such efforts will need to be tax-financed. The role that private providers can play is substantial, even when most funding comes from public sources, but such activity will face greater challenges as more individuals seek benefits. India has also shown that implementation can often be carried out well by states using central government funds, with a set of advantages and disadvantages that such decentralization brings. Finally, India's experience with implementation can offer guidance on issues such as targeting, the use of information technology in social security systems, and human resource management.old age risk, old age benefit, medical care, social security administration, demographic aspect, India