A study of organizational versus individual needs related to recruitment, deployment and promotion of doctors working in the government health system in Odisha state, India

Kadam, Shridhar; Nallala, Srinivas; Zodpey, Sanjay; Hussain, Akhtar; Chauhan, Abhimanyu Singh; Das, Sovesh; Martineau, Tim

doi:10.1186/s12960-016-0103-1

Cited by 20 publications

(26 citation statements)

References 12 publications

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“…The current distribution of specialists across CHCs could be the result of a number of factors ranging from recruitment and deployment policies of the state, to the personal choices made by doctors who, themselves, are affected by several factors such as working environment, amenities, availability of a residence, and travel times, and so on [57, 58]. A recently conducted study revealed that most postings for doctors in the state are highly politicized and it is not unusual for doctors or health workers to use their political influence to cherry-pick their desired facility.…”

Section: Discussionmentioning

confidence: 99%

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Singh¹

2019

BMC Health Serv Res

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Background The onus of providing affordable access to specialist services in rural India primarily lies with publicly funded rural hospitals, also known as community health centres (CHCs). However, no studies have attempted to measure the change in the shortage and distributional inequalities of specialists in the publicly funded rural hospitals of Uttar Pradesh (India). This study attempts to fill that gap. Methods The study uses data from the three latest rounds of the District-Level Household Survey, covering a period of 10 years spanning from 2002 to 2012. Shortages were measured against the Indian Public Health Standards for CHCs, and inequalities were measured using Gini and Theil indices, with the latter decomposed to reveal the source of the inequalities. Negative binomial regression was applied to examine the association between facility characteristics and the availability of specialists in CHCs. Results The current shortage of specialists stands at 80.7% of the total requirement. Currently, 62.1% of CHCs are functioning without a specialist. The distribution of specialists across CHCs has become progressively uneven over the study period, as shown by the rise in the Gini index (from 0.41 in 2002–2004 to 0.74 in 2012–2013). Decomposition analysis reveals that the contribution of within-district inequalities to overall inequality remains high (85.4% of total inequality). About 50% of within-district inequality is contributed by only 20 districts, most of which belong to eastern and central Uttar Pradesh. The analysis of factors affecting the distribution of the current specialist workforce revealed that the number of available specialists at a CHC is positively associated with the availability of residences for doctors and regular electricity supply, and negatively associated with CHC location and the distance of the CHC from the district headquarters. Conclusion The findings suggest that Uttar Pradesh not only needs to recruit more specialists, but it also requires proper implementation of deployment and retention policies to ensure equitable access to specialist care for rural populations. Ensuring the availability of quality accommodations and basic amenities at all CHCs, as well as adequate transport and rural allowance, could help increase the chances of specialists staying in rural and far-off CHCs.

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Section: Discussionmentioning

confidence: 99%

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Singh¹

2019

BMC Health Serv Res

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“…In Nepal, career paths were seen to be important to keeping staff in service [ 34 ]. Research in India found that the tensions between organisational and individual goals can be difficult to align in postings and transfers, particularly in contexts of ambiguous or ‘pliable’ policies and staff shortage, which makes manipulation of the system from the perspective of either managers or staff possible [ 35 ]. In Nigeria, Abimbola and colleagues point to three functions of postings and transfers, including its routineness improving system performance, or punishment of staff, and how the lack of clear policy leads to differential postings and transfers practice which does not always lead to equitable distribution of staff [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Postings and transfers in the Ghanaian health system: a study of health workforce governance

Kwamie

Asiamah²,

Schaaf

et al. 2017

Int J Equity Health

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BackgroundDecision-making on postings and transfers – that is, the geographic deployment of the health workforce – is a key element of health workforce governance. When poorly managed, postings and transfers result in maldistribution, absenteeism, and low morale. At stake is managing the balance between organisational (i.e., health system) and individual (i.e., staff preference) needs. The negotiation of this potential convergence or divergence of interests provides a window on practices of postings and transfers, and on the micro-practices of governance in health systems more generally. This article explores the policies and processes, and the interplay between formal and informal rules and norms which underpin postings and transfers practice in two rural districts in the Greater Accra Region of Ghana.MethodsSemi-structured interviews were conducted with eight district managers and 87 frontline staff from the district health administration, district hospital, polyclinic, health centres and community outreach compounds across two districts. Interviews sought to understand how the postings and transfers process works in practice, factors in frontline staff and district manager decision-making, personal experiences in being posted, and study leave as a common strategy for obtaining transfers.ResultsDifferential negotiation-spaces at regional and district level exist and inform postings and transfers in practice. This is in contrast to the formal cascaded rules set to govern decision-making authority for postings and transfers. Many frontline staff lack policy clarity of postings and transfers processes and thus ‘test’ the system through informal staff lobbying, compounding staff perception of the postings and transfers process as being unfair. District managers are also challenged with limited decision-space embedded in broader policy contexts of systemic hierarchy and resource dependence. This underscores the negotiation process as ongoing, rather than static.ConclusionsThese findings point to tensions between individual and organisational goals. This article contributes to a burgeoning literature on postings and transfers as a distinct dynamic which bridges the interactions between health systems governance and health workforce development. Importantly, this article helps to expand the notion of health systems governance beyond ‘good’ governance towards understanding governance as a process of negotiation.

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“…Job or 'work' histories have been used in disciplines such as hospitality (9), labour market analysis (10) and health sector, more specifically occupational and environmental health (11,12). Some HRH related research also exist that use job histories as a method to examine the policy implementation (5,6,13).…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Experience and reflections of using individual work histories and events of public sector doctors to unpack Human Resource Management policies and systems: Job histories as powerful method in Human Resource for Health research

Purohit

Hill

2020

Preprint

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Background and methods: There is limited use of job histories in Human Resource for Health (HRH) research. This paper presents authors’ reflections of using job histories in HRH related research. In particular paper discusses how these can be useful method specifically to examine the implementation fidelity for health policy analysis of HRH and the strengths and limitations of this approach. Methods: The context of this exploration is a multiple case study research project examining the implementation of HRH policies in public health sector in two Indian States—Sikkim and Rajasthan. As the doctors were the main subjects of the study, semi-structured interviews were conducted with 33 doctors to understand their experiences and interactions with the health department in relation to four key HRH management functions: recruitment, initial posting, transfer and promotions. The interview process revealed construction of work life related chronology by the doctors as a means of structuring their responses. This emerging pattern was adapted for the subsequent interviews to formalise it in form of job histories. Key findings and reflection: Job histories constructed from the interviews gave rich descriptive accounts of doctors’ experiences with the HRM systems, and also unravelled how HRM policies and systems operate, specifically in relation to adherence and dosage aspects of implementation fidelity, represented as narrative and quantitative accounts. For instance, job histories clearly allude non-adherence to posting rules and norms. Similarly, examination of the dosage aspect suggests variable application of HRH related policies and practices, delivered inconsistently across the doctors (applied to some and not to others or not applied consistently to the same doctor across his/her work career) or not applied as often as required. The organic and fluid nature of the job histories grounded in the qualitative data presents itself as a very powerful case in narrating rich job related stories and experiences of doctors. Additionally, it offers the flexibility to collect data in a more structured way potentially demonstrating useful chronological patterns and offering valuable insights into attempts to unravel the complexities and conflicts and in unpacking the rich individual experience, conflicts and tensions that public sector rural doctors confront in interacting with HRM policies and systems. Job histories can serve as a useful method for data collection in the area of Health Policy and Systems Research implementation, especially in relation to HRH.

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A study of organizational versus individual needs related to recruitment, deployment and promotion of doctors working in the government health system in Odisha state, India

Cited by 20 publications

References 12 publications

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012

Postings and transfers in the Ghanaian health system: a study of health workforce governance

WITHDRAWN: Experience and reflections of using individual work histories and events of public sector doctors to unpack Human Resource Management policies and systems: Job histories as powerful method in Human Resource for Health research

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