Veena Sriram, Shreya Hariyani, Ummekulsoom Lalani, Ravi Teja Buddhiraju, Pooja Pandey & Sara Bennett
In India, the distribution and retention of biomedical doctors in public sector facilities in rural areas is an obstacle to improving access to health services. The Government of Uttar Pradesh is developing a comprehensive, ten-year Human Resources for Health (HRH) strategy, which includes policies to address rural distribution and retention of government doctors in Uttar Pradesh (UP). We undertook a stakeholder analysis to understand stakeholder positions on particular policies within the strategy, and to examine how stakeholder power and interests would shape the development and implementation of these proposed policies. This paper focuses on the results of the stakeholder analysis pertaining to rural distribution and retention of doctors in the government sector in UP.
Our objectives are to 1) analyze stakeholder power in influencing the adoption of policies; 2) compare and analyze stakeholder positions on specific policies, including their perspectives on the conditions for successful policy adoption and implementation; and 3) explore the challenges with developing and implementing a coordinated, ‘bundled’ approach to strengthening rural distribution and retention of doctors.
We utilized three forms of data collection for this study – document review, in-depth interviews and focus group discussions. We conducted 17 interviews and three focus group discussions with key stakeholders between September and November 2019.
We found that the adoption of a coordinated policy approach for rural retention and distribution of doctors is negatively impacted by governance challenges and fragmentation within and beyond the health sector. Respondents also noted that the opposition to certain policies by health worker associations created challenges for comprehensive policy development. Finally, respondents believed that even in the event of policy adoption, implementation remained severely hampered by several factors, including weak mechanisms of accountability and perceived corruption at local, district and state level.
Building on the findings of this analysis, we propose several strategies for addressing the challenges in improving access to government doctors in rural areas of UP, including additional policies that address key concerns raised by stakeholders, and improved mechanisms for coordination, accountability and transparency.
This brief identifies the opportunity gaps in the effective coverage cascade for prevention of anaemia among pregnant women in India. The effective coverage cascade is used to identify coverage gaps, quantify coverage at each step, determine where the largest gaps exist within the cascade and prioritize where actions are most urgent. The findings are based on NFHS 5 data.
The 14th issue of PAHAL offers insights on UP TSU’s work in the second quarter of 2022. This issue provides an update on the initiatives taken by UP TSU for enhancing the availability of Iron Folic Acid supplementation for pregnant women, accelerating PPH Emergency Care by Bundle Approach, the activation of district hospital level validation committee meetings and other key interventions.
PAHAL Issue 13 highlights the efforts of Government of Uttar Pradesh in conducting Skilled Birth Attendants (SBA) trainings, with support from UP TSU. This edition also includes the integration of PPIUCD training with SBA training for staff nurses and ANMs along with many more updates of