Health System Performance and the Extent of Engagement of the Local Self Government Institutions - A Qualitative Study from Rajasthan, India (original) (raw)
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Local self governance in health - a study of it’s functioning in Odisha, India
Background: Local decision making is linked to several service quality improvement parameters. Rogi Kalyan Samitis (RKS) at peripheral decision making health units (DMHU) are composite bodies that are mandated to ensure accountability and transparency in governance, improve quality of services, and facilitate local responsiveness. There is scant literature on the nature of functioning of these institutions in Odisha. This study aimed to assess the perception of RKS members about their roles, involvement and practices with respect to local decision making and management of DMHUs; it further examined perceptual and functional differences between priority and non-priority district set-ups; and identified predictors of involvement of RKS members in local governance of health units. Methods: As members of RKS, health service providers, officials in administrative/managerial role, elected representatives, and officials from other departments (including independent members) constituted our study sample. A total of 112 respondents were interviewed across 6 districts, through a multi-stage stratified random sampling; we used a semi-structured interview schedule that comprised mainly of close-ended and some open-ended questions. Descriptive and inferential statistics were used to compare 3 priority (PD) and 3 non-priority districts (NPD), categorized on the basis of Infant Mortality Rate (IMR) estimates of 2011 as proxy of population health. Governance, human resource management, financial management and quality improvement functions were studied in detail. Opinion about various individual and organizational factors in local self-governance and predictors of involvement were identified. Results: The socio-demographic profile and composition of respondents were comparable between PD and NPD. Majority of respondents were 'satisfied' with their current roles in the governance of local health institutions. About onefourth opined that the amount of funds allocated to RKS under National Health Mission (NHM) was 'grossly insufficient'. Fifty percent of respondents said they requested for additional funds, last year, and 38.8 % informed that they requested additional funds for purchase of drugs. About 87 % respondents were satisfied with their role in the local governance of the health units (PD = 94.3 % vs. NPD = 80.7 %). Almost all (PD = 98 % vs. NPD = 80.7 %) opined that local decision making helped in improving the performance of health units. For most of the open-ended questions the responses were non-specific. Staggering differences were found between PD and NPD with respect to their involvement in district plan preparation (NPD = 78.9 % vs. PD = 58.5 %), training in plan preparation (NPD = 47.4 % vs. PD = 27.5 %), participation of officials from other departments (PD = 96.9 % vs. NPD = 45.5 %), and inclusion of activities of other sectors (PD = 70. 8 % vs. NPD = 41.8 %). Whereas, no significant PD-NPD difference was found about their perceived 'involvement' in undertaking the 12 designated responsibilities. Composite scores on various individual and organizational factors were compared and found to be varying significantly. Through regression, we inferred work experience, qualification and nonmonetary incentives as strong determinants of current level of involvement of RKS members in governance and management of health units.
National Journal of Community Medicine, 2017
Introduction: National Health Mission (NHM) was envisaged with the core objective of decentralization and health systems strengthening. The study tried to assess the utilization pattern of untied fund allocated to Rogi Kalyan Samitis of community health centers and primary health centres across the Gujarat. Methodology: Routine reporting of the Financial Management Reports was analysed to assess utilization pattern of financial year 2013-14. Results: RKS is predominantly using the fund to cover up the local needs at facility levels like outsourcing of the staff (10%), minor civil works (12%), drugs-consumables and logistics (24%). The contingency expenditure takes a large section too. Miniature part has been utilised for the day to day expenses of the facilities like printing, linen & training. This can be attributed to structural and managerial role of the system. Moreover NHM need to improve the mechanism for benefitting local community and utilization of the funds through RKS. Conclusion: Study emphasize a need for devising strategies and planning to fulfil the civil works, shortfall of staff, drugs procurement & efficient supply chain management to overcome the burden. Knowledge base of members needs to be strengthened for a clear understanding of the objectives, functioning and roles of RKS.
South East Asia Journal of Public Health, 2015
In India, the National Rural Health Mission envisaged of having committees with civil society representation at all publicly financed hospitals known as Rogi Kalyan Samiti (RKS), with mandate to enhance governance in hospitals. There are limited evidences about functioning of these committees in many states, especially in North Eastern (NE) states. This paper analyses the perspective of RKS members and relate to changing community-health system structure for improved governance. The study was conducted in three states Manipur, Meghalaya, and Tripura of NE Region of India. Using stratified sampling design, 14 RKS/facilities were selected from Manipur, 15 from Meghalaya and 11 from Tripura. Two key informants (mainly, president/secretary of RKS) were interviewed using a semi-structured pre-tested questionnaire in local language. The major areas of RKS operationalization identified include; constitution, finance management and activities related to health systems strengthening. RKS was constituted during 2006-07 with governing body following issuance of government of India guidelines. The funds (grants and User Fee) were utilized for purchase of furniture, bio-medical waste management etc. The governing body meetings focused mainly on ensuring services; in Tripura 72% of RKS had regular meetings and have shown improvement in functioning of facilities.Formation of RKS model paved way to a new beginning for strengthening health system with involvement of local leaders, civil society to improve governance. The functioning is derived by availability of resources, capacity of committee members and the bureaucratic process. Revision in functioning of RKS model is essential towards self-sustainability and bridge between community-health systems.
2012
The present study employing the 2006 Rural and Demographic Survey data, describes people's perceptions of the existence of the health problems, the performance of the decentralized institutions, namely the panchayats and people's participation in the regime of decentralized governance. The multivariate analyses estimate health care access, work days lost owing to illness and the treatment cost as a proportion of household income. Findings indicate that while there is a significant percentage of population that perceives the existence of the problem of the availability and accessibility of quality health care, there has been some increase in the significance accorded to health issues in the public discourse held in decentralized settings such as panchayat and gram sabha meetings. There are significant regional differences with the states of the South relative to the other parts, showing a more active role of the panchayat. The contrast is particularly notable when compared to the North. However, greater action by the panchayats is also associated with greater level of dissatisfaction, pointing towards some form of the paradox of participation. The multivariate estimates portray a positive role of decentralized governance in predicting health care access, loss of work days owing to illness and cost of treatment as a proportion of household income.
RePEc: Research Papers in Economics, 2011
Institute for Social and Economic Change (ISEC) is engaged in interdisciplinary research in analytical and applied areas of the social sciences, encompassing diverse aspects of development. ISEC works with central, state and local governments as well as international agencies by undertaking systematic studies of resource potential, identifying factors influencing growth and examining measures for reducing poverty. The thrust areas of research include state and local economic policies, issues relating to sociological and demographic transition, environmental issues and fiscal, administrative and political decentralization and governance. It pursues fruitful contacts with other institutions and scholars devoted to social science research through collaborative research programmes, seminars, etc. The Working Paper Series provides an opportunity for ISEC faculty, visiting fellows and PhD scholars to discuss their ideas and research work before publication and to get feedback from their peer group. Papers selected for publication in the series present empirical analyses and generally deal with wider issues of public policy at a sectoral, regional or national level. These working papers undergo review but typically do not present final research results, and constitute works in progress.
Bottom's up: to the role of Panchayati Raj Institutions in health and health services
2006
India is currently witness to two trends that have the potential to significantly improve the health of its people. The first is the growing recognition that the system of public delivery of health services is in crisis. The second trend is India's bold efforts to strengthen the voice of the rural poor through decentralization to local governments. This paper argues that these two ostensibly separate trends can converge to generate real reform in the health sector in India through the potential for increased accountability that local governments can provide. The paper is structured as follows: Section I begins with some prefatory remarks setting the context for discussion of health, health care and health policy in India, which is necessary to understand the role that decentralized decisionmaking can play. To make the policy options concrete we briefly review two broad categories of health policy; Section II addresses the problem from the view of standard economic analysis; Sect...
Background Reaching hard to reach populations is key to reduce health inequities. Despite targeted interventions, status of crucial public health indicators like neonatal and maternal mortality is still far from optimal. Complex interplay of social determinants can influence both communities and health care workers to effectively access each other. We argue that culturally sensitive and contextually relevant healthcare provision has potential to increase health care utilization by the vulnerable communities living in remote areas. Methods The study is an exploratory case study using rapid ethnographic techniques to understand the interplay of social determinants in hard to reach areas of Odisha state, India. We used in-depth interviews, focus group discussion, participatory action research and key informant interviews as tools for data collection. The analysis of data has been guided by thematic analysis approach. Results We found that there are further layers within the designated hard to reach areas and those can be designated as-i) extremely remote ii) remote and iii) reachable areas. Degree of geographic difficulties and cultural dynamics are deciding the 'perceived' isolation and interaction with health care providers in hard to reach areas. This ultimately leads to impacting the utilization of the facilities. At extremely remote areas, felt health needs are mainly fulfilled by traditional healers and ethno-medical practices. In reachable areas, people are more prone to seek care from the public health facilities because of easy accessibility and outreach. Being in middle people in remote areas, diversify health care seeking depending upon social (e.g. patient's gender) economic (e.g. avoid catastrophic expenditure) and health system (timely availability of health human resources, language barriers) factors. Conclusion Our research highlights the need to value and appreciate different worldviews, beliefs and practices, and their understanding of and engagement with the pluralistic health care system around them. Other than pursuing the 'mainstreaming' of a standardized health system model across hard to reach areas, strategies need to be adaptive as per local factors. To handle that existing policies need revision with a focus on culturally sensitive and contextual care provision.
Does local democracy improve public health interventions? Evidence from India
2021
Health care decisions in many low-income countries often require a close political agency relationship between healthcare decision makers and constituents. This is especially the case for maternal and child care as well as preventative interventions when resources are scarce. This article examines the effect of the introduction of the National Rural Health Mission in India, introducing Village Health, Sanitation and Nutrition Committees (VHSNC), a self-governance mechanism to strengthen the political agency in village health care decision making. We study the effect of exposure to VHSNC on both maternal and preventative child health care. We find that exposure to VHSNC's increase the utilization of several maternal health care services, but does not systematically increase the uptake of preventive health care. The effect of VHSNC is more intense in larger villages and areas closer to district headquarters, and is driven by an increase in the utilization of the public healthcare ...