شیوه های مدیریت در بوروکراسی بهداشت عمومی
Abstract
1- Introduction
2- Literature on management
3- Methods
4- Results
5- Discussion
References
Abstract
Weak management is widely recognised as a key impediment to scaling-up coverage of health interventions and ensuring health systems are responsive to population needs. Yet there is scant evidence linking management practices in the public administration to effective health service delivery. We report on the development of a tool to measure management practices in India's district health bureaucracy. We first developed a conceptual framework based on a review of the literature and qualitative interviews with district public health managers. Across 16 management practices, we then drafted and piloted questions to be used with a scoring grid to evaluate process-orientated management practices. We implemented the tool in 34 districts of Maharashtra between April and July 2016, interviewing up to three district public health managers per district (n = 99). Using rigorous psychometric methods, we assessed the acceptability, reliability and validity of the tool. We present three key findings. First, the tool was feasible to implement, response rates were high, and there were no missing data. Second, internal consistency of the tool was high and test-retest reliability was comparable with other management tools used in the literature. Third, there was evidence of validity. The number of staff with a management qualification was positively associated with better management practices. Factor analysis showed that one principal component loaded positively on all the management practices although there was little support for management sub-scales. These findings provide novel evidence on the psychometric properties of a tool designed to measure management practices in the public administration of a developing country. Our framework and tool provide the basis to examine associations between district health management practices and health service delivery, and test the effectiveness of management strengthening interventions in India's public health sector.
Introduction
Weak public service delivery has long been regarded as a key obstacle to ensuring widespread coverage of essential health interventions (Travis et al., 2004). Nowhere is the issue more salient than India, where the state has struggled to deliver basic public services to its population, despite the presence of elite national institutions and a highly educated top brass of public administrators (Pritchett, 2009). This is perhaps best reflected in the absenteeism of frontline health workers in the public sector, estimated at 40 percent (Muralidharan et al., 2011). One reason for the current situation is possibly poor managerial quality in the public administration. Weak management is widely recognised as a key impediment to scaling-up coverage of health interventions (Mangham and Hanson, 2010) and ensuring health systems are responsive to population needs (de Savigny and Adam, 2009). Yet there is a dearth of evidence linking practices in the public administration to effective service delivery and outcomes (Goldfinch et al., 2012). With a few exceptions (Rasul and Rogger, 2018), much of the literature on management has focused on private firms or service delivery organisations, such as hospitals, schools and universities (Bloom et al., 2014; Bloom and Van Reenen, 2007; McCormack et al., 2014). In health systems and policy research, management has received little attention. Management is almost absent in commonly used frameworks on health system performance, falling under broader notions of “stewardship” and “governance” (WHO, 2007b).