La Forgia, GerardRaha, ShomikhoShaik, ShabbeerMaheshwari, Sunil KumarAli, Rabia2014-07-302014-07-302014-06https://hdl.handle.net/10986/19065There is building evidence in India that the delivery of health services suffers from an actual shortfall in trained health professionals, but also from unsatisfactory results of existing service providers working in the public and private sectors. This study focusses on the public sector and examines de facto institutional and governance arrangements that may give rise to well-documented provider behaviors such as absenteeism, which can adversely affect service delivery processes and outcomes. The paper considers four human resource management subsystems: postings, transfers, promotions, and disciplinary practices. The four subsystems are analyzed from the perspective of front line workers, that is, physicians working in rural health care facilities operated by two state governments. Physicians were sampled in one post-reform state that has instituted human resource management reforms and one pre-reform state that has not. The findings are based on quantitative and qualitative measurement. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect.en-USCC BY 3.0 IGOABILITY TO PAYACCOUNTABILITIESACCOUNTABILITYACCOUNTABILITY MECHANISMSAGEDANTI-CORRUPTIONASSETSAUDITORAUDITORSBASIC SERVICESBULLETINCAPACITY BUILDINGCITIZENCITIZENSCIVIL SERVANTCIVIL SERVANTSCIVIL SOCIETYCOLLUSIONCOMMUNITY HEALTHCONFIDENCECORRUPTIONCOUNSELINGCRIMINALCRIMINAL LAWDECISION MAKINGDELIVERY OF HEALTH CAREDELIVERY OF HEALTH SERVICESDELIVERY SYSTEMDELIVERY SYSTEMSDEMOCRACYDEVELOPING COUNTRIESDEVELOPMENT POLICYDISEASESDOCTORSECONOMIC PERSPECTIVESECONOMIC POLICIESECONOMIC REVIEWEVALUATION TECHNIQUESFAMILY WELFAREFEMALE LITERACYFINANCIAL RESOURCESFOCUS GROUP DISCUSSIONSGOOD GOVERNANCEGOVERNMENT AGENCIESGOVERNMENT OFFICIALSHEALTH AFFAIRSHEALTH CAREHEALTH CARE DELIVERYHEALTH CARE FACILITIESHEALTH CARE SERVICESHEALTH CARE SYSTEMHEALTH CARE UTILIZATIONHEALTH CENTERSHEALTH CENTRESHEALTH COMMITTEESHEALTH DELIVERYHEALTH DELIVERY SYSTEMHEALTH FINANCINGHEALTH INFRASTRUCTUREHEALTH INSURANCEHEALTH INSURANCE SCHEMEHEALTH INSURANCE SCHEMESHEALTH OFFICIALSHEALTH OUTCOMESHEALTH PLANSHEALTH PROFESSIONALSHEALTH SECTORHEALTH SERVICEHEALTH SERVICE DELIVERYHEALTH SERVICESHEALTH SERVICES RESEARCHHEALTH SYSTEMHEALTH SYSTEM PERFORMANCEHEALTH SYSTEMSHOSPITALHOSPITALSHOUSEHOLD SURVEYSHRHUMAN RESOURCE MANAGEMENTHUMAN RESOURCESHUMAN RESOURCES MANAGEMENTIMMUNIZATIONINCOMEINCOME DISTRIBUTIONINFORMAL SECTORINPATIENT CAREINSURANCE SCHEMESINTERMEDIARIESINTERNAL MIGRATIONKICKBACKSLEADERSHIPLOCAL COMMUNITYLOW-INCOME COUNTRIESMANAGEMENT SYSTEMSMARITAL STATUSMEDICAL SCHOOLMIGRATIONMINISTERMINISTRIES OF HEALTHMINISTRY OF HEALTHMINORITYMORBIDITYMORTALITYNATIONAL HEALTHNATIONAL HEALTH SYSTEMSNURSENURSESNURSINGNUTRITIONOUTPATIENT CAREPATIENTPATIENT CHOICEPATIENTSPATRONAGEPEDIATRICSPENSIONSPHYSICIANPHYSICIANSPLACE OF RESIDENCEPOLICY DISCUSSIONSPOLICY MAKERSPOLICY RESEARCHPOLICY RESEARCH WORKING PAPERPOLITICAL CHANGEPOLITICAL CORRUPTIONPOLITICAL LEADERPOLITICAL LEADERSPOLITICAL PARTIESPOLITICAL SUPPORTPOLITICIANPOLITICIANSPOLLUTIONPOOR HEALTHPOPULAR SUPPORTPRIMARY CAREPRIVATE CAREPRIVATE HEALTH SERVICESPRIVATE SECTORPRIVATE SECTORSPROBABILITYPROGRESSPSYCHOLOGYPUBLIC ADMINISTRATIONPUBLIC HEALTHPUBLIC HEALTH CAREPUBLIC HEALTH SERVICESPUBLIC HEALTH SYSTEMPUBLIC HEALTH WORKERSPUBLIC HOSPITALSPUBLIC OFFICIALSPUBLIC OPINIONPUBLIC PROVIDERSPUBLIC SECTORPUBLIC SERVICEPUBLIC SERVICESPUBLIC SPENDINGQUALITY CAREQUALITY OF CAREQUANTITATIVE RESEARCHREFORM EFFORTRESEARCH METHODSRURAL AREASRURAL HEALTH CARESANCTIONSSANITATIONSENSITIVE ISSUESSENSITIVE TOPICSSERVICE PROVIDERSSERVICE PROVISIONSOCIAL DEVELOPMENTSOCIAL INFRASTRUCTURESPOUSESPOUSESSTATE GOVERNMENTSTATE GOVERNMENTSSURGERYTHEFTTRANSPARENCYURBAN AREASURBAN CENTERSVICTIMSWORKERS10.1596/1813-9450-6953