Health Sector, State and Decentralised Institutions in India by Shailender Kumar Hooda

Author:Shailender Kumar Hooda [Hooda, Shailender Kumar]
Language: eng
Format: epub
Tags: Development, Public Policy, Social Services & Welfare, Developing & Emerging Countries, Social Science, Political Science, Business & Economics, Sociology, General
ISBN: 9781000456929
Google: qKdMEAAAQBAJ
Publisher: Taylor & Francis
Published: 2021-11-29T09:50:28+00:00

5

Decentralisation in health

Rationale, measurements and effectiveness1

DOI: 10.4324/9781032108438-7

Well-documented phenomena are that public investment in health influences health outcomes positively (Barenberg et al., 2016; Arthur and Oaikhenan, 2017; Rahman et al., 2018), reduces health gaps/inequalities (Barenberg et al., 2016), addresses many preventable and untimely deaths (GBD, 2018) and helps in achieving universal health coverage. If health system advances and investments made do not keep the pace with population health needs, one can expect slow progress in securing better health outcomes (GBD, 2018). Any restriction on spending would have devastating impact on child mortality (Breman and Shelton, 2001; Maruthappu, 2015), especially for low-income groups in developing countries (Gupta et al., 2001; Gwatkn, 1999 & 2000) more than the high-income countries (Tandon, 2005). Despite such encouraging results, health systems of many developing countries are facing underfunding problems, alongside inefficiencies in utilisation of the scanty amounts of funding allocated towards the sector. The inefficiency in fund utilisation is a general phenomenon in the context of policies addressing unemployment, poverty, inequality and management of public health services which require a set of institutional reforms (Cassel, 1995). Citing a relationship between life expectancy at birth with the resources that countries devote to health, Berman and Bitran (2011) presented a high variability in the relationship between performance and spending, demonstrating the weak link between these two. It indicated that variables like quality of policies and institutions play a greater role for health system performance. The study by Chaudhury et al. (2006), while citing a case of absenteeism of health staffs from health facility of 35–40%, indicated that the weak institutions for supplying public goods like healthcare are a significant barrier to economic development in many countries. The much recent discussion of economic development therefore revolves around the role of institutions that strengthen governance.

The idea of institutional economic reforms is increasingly being applied to understanding and accelerating the process of economic development, as well as for shaping the sector-specific outcome from an efficiency point of view that influences the outcomes directly or indirectly via improving the efficacy of resource utilisation. Earlier, the idea of institutions arose in critical response to the neoclassical theory – in particular, the inadequacy of the neoclassical theory in dealing with uneven performance of economies across space and time, and its limited potential to explain persistence of inefficient institutions and role of ideology in choice determination of individuals (North, 1997). Neoclassical economics does not deal with the incentives and behaviour of political actors, or the influence of political processes on target for growth, stability or the division of public investment among sectors (Eggertsson, 1997).

It is increasingly being realised that these factors play critical roles in explaining persistent unevenness across space and time. Literature indicates that neoclassical economics completely ignores the ‘power’ dimension in policy making (Schmid, 1978). The framework has also been criticised for construction of its own ‘idealised’ world, one that it does not encompass the reality and efficacy of transaction costs (Williamson, 1990). The framework offers no scope to integrate politics into economics

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