Summary

Despite significant improvements having been achieved in public health since independence, this area continues to be “one of the most neglected aspects” of government policy. (Dreze and Sen, 2002).
This paradox is examined and addressed by:
- The concept of power in the health system and how it is used to influence policy.
- Focusing on the implementation level of institutions.
- Analyses on the existing disconnect between the grand strategies at national level policy planning and the more immediate problems that the bureaucrat officials (tasked with the implementation of policies) are preoccupied with at the institutional level. 

India is one of the pioneers in health service planning and in recognizing human resources as key to a well-functioning system.  The first independent government of India had no less than three significant reports on health policy planning even before it initiated the first of its Five-Year Plans.¹ Ever since, each subsequent Plan until the current eleventh one, has strived with all good-intention to strategize on elements of human resource development for better health care provision.  There is no doubt that significant improvements in health have been achieved since independence, particularly in the lowering of infant mortality and a steady increase in life expectancy.  Nevertheless, public health has been “one of the most neglected aspects” of government policies for furthering development in the country (Dreze and Sen, 2002).  An overall objective of this paper is to attempt an understanding and explanation of this paradox, but it is principally driven by two broad aims: First, it aims to analyze the political-economic context of health policy in India through clarity on the distribution of power in the health system and the influences that determine policy content on human resources for health.  Second, it aims to bring focus especially to the institutional context in which policies pertaining to human resources for health are implemented.   

Structure of the Paper

This paper is organized into four parts.  Part I addresses the concept of power in the health system and how it is used to influence the contents of policy.  The sections here focus separately on power-sharing between governments in a federal system, the extent of interest-group influence on policy, financial mechanisms to influence policy and a review of policy content in past decades.  The common emphasis in all these sections is on the national level of policy strategizing.  In contrast, Parts II and III of the paper are at the implementation level of institutions.  The paper makes use of empirical data from two selected cases introduced in the first section of Part II: (i) the Central Health Service (CHS) managed by the central health ministry; and (ii) the Uttar Pradesh (UP) health system managed by the state government.  The subsequent section in Part II outlines the methodology the paper uses for the research in the remainder of Parts II and III, focusing on institutions tasked with the implementation of policies. 

The discussion in Part IV draws on the analyses in the different sections of the paper to make the following observation: there is an existing disconnect between problems that the grand strategies prioritize at the national level of policy planning and the more immediate problems that the bureaucrat officials are preoccupied with at the institutional level tasked with the implementation of policies.  It argues that this disconnect is an important reason why policies planned at the national level pertaining to HRH do not easily translate into implementation and that this disconnect remains still largely overlooked. This may also go to explain the above paradox of significant planning and strategizing still amounting to perceived ‘neglect’ of public health due to poor implementation.