Implications of Human Resource Practices and Other Structural Factors on Commitment of Public Medical Professionals in India

In this paper we focus on often neglected issue and inadequately studied area of commitment of public sector health professionals and some of the issues surrounding human resources as its determinants. The paper argues that success or failure of new initiatives in health sector critically hinges on the commitment of the staff. This paper is based on the questionnaire study and focused group discussion of 175 doctors working as district medical officers at district level and holding key administrative positions at state level in four states in India. These four Indian states account for nearly 22 per cent of India’s population. The findings provide some important insights that would be useful in drawing future agenda of strengthening health sector and involving all stakeholders in implementation process. The study finds critical linkage between human resource (HR) practices and commitment of doctors working in the government. Specifically, following HR practices are found critical in influencing organizational commitment: transparency in selection/postings, supportive training and capacity strengthening climate, recognition of performance and regular performance feedback. Further, results suggest that certain work environment and structural factors facilitate these practices. Health officials’ roles need to be redefined and given complexity of coordination at various levels, officials need to be allocated higher responsibilities. There is also a need to improve interpersonal relations within departments and coordination among agencies and officials at various levels. It is also observed that the structural rigidities in the system leading to obstruction in information sharing across various levels needs to be addressed to ensure effective healthcare delivery. This study highlights the criticality of administrative and structural issues for reforms of healthcare sector in India. Addressing human resources issues is critical for ensuring commitment from staff in implementing new initiatives or health reform agenda. National Rural Health Mission (NRHM) also identifies the human resources and capacities as an important challenge. Institutions that are critical vehicles to implement the NHRM would remain weak owing to low commitment of people. It would be important to focus on HR issues before any new initiative is proposed and implemented. The departments of health across states need to broaden and deepen the understanding of HR management and planning issues. For this purpose they may need to set-up HR division having appropriate competency and skill-mix to address the issues and work towards making the right changes. The papers discusses that these changes will be required at both strategic and operational levels.