Local governance : bureaucratic performance and health care delivery in Calcutta
This thesis is based on a comparative case study of two bustee neighbourhoods located in two separate wards of Calcutta, and of the factors which have affected the performance of public officials providing primary health care services to their inhabitants. It is argued that poor bureaucratic performance and a lack of accountability lie at the heart of problems with the health system in West Bengal. The thesis evaluates the effectiveness of 'governance' reforms, comprising decentralisation and the application of the principles of New Public Management (NPM), on the performance of public officials. NPM and decentralisation apply the core assumptions of neo-classical economics to the study of bureaucratic decision-making. The thesis argues that local officials in Calcutta may not always have chosen to behave in a way which maxmised their personal welfare, but that history, culture and politics may have affected the choices that they made. The thesis questions the view that decentralization necessarily leads to greater community participation challenges contemporary notions of what constitutes 'civil society' and suggests a more nuanced view of the relationship between civil society and good government. It questions NPM's claims to universality, which have resulted in its widespread application without due regard to local context, and argues that NPM inspired reforms have had a limited effect on health officials in Calcutta, in part, because of their failure to address the underlying causes of poor bureaucratic performance. The final chapter argues that the political influence of public sector workers has affected the willingness of the ruling Party to enforce the incentives to improve the performance of health care officials in West Bengal.