| Abstract: |
In this paper we focus on often neglected issue and inadequately studied area
of commitment of public sector health professionals and some of the issues
surrounding human resources as its determinants. The paper argues that success
or failure of new initiatives in health sector critically hinges on the
commitment of the staff. This paper is based on the questionnaire study and
focused group discussion of 175 doctors working as district medical officers
at district level and holding key administrative positions at state level in
four states in India. These four Indian states account for nearly 22 per cent
of India’s population. The findings provide some important insights that would
be useful in drawing future agenda of strengthening health sector and
involving all stakeholders in implementation process. The study finds critical
linkage between human resource (HR) practices and commitment of doctors
working in the government. Specifically, following HR practices are found
critical in influencing organizational commitment: transparency in
selection/postings, supportive training and capacity strengthening climate,
recognition of performance and regular performance feedback. Further, results
suggest that certain work environment and structural factors facilitate these
practices. Health officials’ roles need to be redefined and given complexity
of coordination at various levels, officials need to be allocated higher
responsibilities. There is also a need to improve interpersonal relations
within departments and coordination among agencies and officials at various
levels. It is also observed that the structural rigidities in the system
leading to obstruction in information sharing across various levels needs to
be addressed to ensure effective healthcare delivery. This study highlights
the criticality of administrative and structural issues for reforms of
healthcare sector in India. Addressing human resources issues is critical for
ensuring commitment from staff in implementing new initiatives or health
reform agenda. National Rural Health Mission (NRHM) also identifies the human
resources and capacities as an important challenge. Institutions that are
critical vehicles to implement the NHRM would remain weak owing to low
commitment of people. It would be important to focus on HR issues before any
new initiative is proposed and implemented. The departments of health across
states need to broaden and deepen the understanding of HR management and
planning issues. For this purpose they may need to set-up HR division having
appropriate competency and skill-mix to address the issues and work towards
making the right changes. The papers discusses that these changes will be
required at both strategic and operational levels. |