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Title: Policy and practice of human resource management in the Indian public health system at district level and its effects on health workers
Author: Kadam, Shridhar
ISNI:       0000 0004 8507 1165
Awarding Body: Liverpool School of Tropical Medicine
Current Institution: Liverpool School of Tropical Medicine
Date of Award: 2020
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Human resource management (HRM) policies and their effective implementation are expected to influence the attitude and behaviour of health workers favourably in providing effective health services to the people. However, within the Indian public health system, it is unclear which HRM policies are implemented effectively and how these influence health workers, especially at district level. This study aimed to explore how HRM policies and practices affect health workers in the Indian public health system. The state of Odisha was purposively selected. Four relevant HRM functions were examined: 1) posting and transfer, 2) in-service training (IST), 3) supervision and review and 4) performance appraisal (PA). Documents including human resources (HR) policies and plans were reviewed to identify intended HRM practices. In-depth interviews of policy makers, managers and health workers were conducted. Using the framework developed by Purcell and Hutchinson, (2007), we identified the relevant intended practices, the practices as reported by the managers and the health workers and their effect on the attitudes and behaviour of health workers. Qualitative data analysis used a 'framework approach'. An in-depth analysis of four HRM functions within the overall human resource management system, as operated at district level within Odisha, has shown that although there may be a weak positive effect on the attitudes and behaviour of public sector health workers, there remain many missed opportunities. Although the design of the majority of HRM systems is logical to achieve the objectives, there are problems in their implementation. The major issues are that either HRM sub-systems are not being operated as designed - with some elements totally missing; or the sub-system is inadequately implemented. Implementation is affected by three major factors: 1) insufficient autonomy of district and facility level managers, 2) lack of resources and skills of the managers and 3) contextual factors including geography, gender and sector reforms. In addition to the inadequate implementation of the HRM system, there are issues in the way the systems are organised and operated, leading to the limited effect of HRM on the attitudes and behaviour of health workers. For instance, the HRM sub-systems are being implemented in isolation, with no connection between the sub-systems of all HRM functions and different 'system owners' at state and district level. With no overall coordination and significant oversights including the monitoring of the system as a whole, opportunities to make this system more efficient are missed. However, the findings from this study provide a very useful starting point for improving the four HRM functions of posting and transfer, in-service training, supervision and review and performance appraisal. Considering these together should help to promote the view of HRM as an overall system, with co-ordinated sub-systems. Therefore, the study concludes that HRM systems can be made more effective to ensure that there is an effective health workforce to deliver the required health care services, and in turn, to contribute to the achievement of the goal of Universal Health Coverage.
Supervisor: Martineau, Tim ; Raven, Joanna Sponsor: Wellcome Trust
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: W 84 Health services. Delivery of health care ; WA 30 Socioeconomic factors in public health (General) ; WA 540 National and state health administration ; WA 546 Local Health Administration. Community Health Services