ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Understanding Government Failure in Public Health Services

High absenteeism, low quality in clinical care, low satisfaction levels with care and rampant corruption plague public health services in India. This has led to mistrust of the system and the rapid growth of private services. This paper develops an analytical framework to understand the status of healthcare in India. Drawing on a model of public sector accountability, it argues that a weak voice and low accountability is the key binding constraint to effective delivery.

Strained Mercy

The quality of medical care is a potentially important determinant of health outcomes, but remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. We address this gap through a survey in Delhi with two related components. We evaluate 'competence' (what providers know) through vignettes and practice (what providers do) through direct clinical observation. Overall quality, as measured by the competence necessary to recognise and handle common and dangerous conditions, is quite low albeit with tremendous variation. While there is some correlation with simple observed characteristics, there is still an enormous amount of variation within such categories. Further, even when providers know what to do they often don't do it in practice. This appears to be true in both the public and private sectors but for very different, and systematic, reasons. The study has important policy implications for our understanding of how market failures and failures of regulation in the health sector affect the poor.
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