Organization of Indian Health Bureaucracy and its Delivery System

The aim of this paper is to probe into the structure and functioning of health bureaucracy in India with specific reference to rural health bureaucracy of Tamil Nadu State. bureaucracy is defined as "a hierarchical division of staff who act on formal assignments" - Gouldner(1954). This definition suggests five specific dimensions of bureaucracy namely (i) hierarchical structure (ii) nature of work and progress (iii) procedural devices (iv) decision making and (v) procedural bottlenecks have been considered in this order to understand the functioning of bureaucracy. These factors are particularly relevant to the understanding of bureaucratic functioning as the previous studies have indicated that the magnitude of these attributes varies from one organization to another (Hall, Peabody, Meyer) 1. The functional complexities of any bureaucratic system largely depend upon the combination of these attributes (Bennis). Health care delivery system is a system in which the services related to health care delivered to the target population. In Health care the higher-level officials do only planning while the local staff do implementation. In India including Tamil Nadu, the implementing agency of health care programmes is at block level known as Primary Health Centers (P.H.C.). In such a kind of setup, whether the centralised approach will be effective? Whether the mechanistic and vertical delivery system will achieve the health care to all sections of society? What are the merits and demerits of mechanistic model? The paper would like to address the above questions in the present context. It also would like to present the health delivery of Non Governmental Organisations. The nature of hierarchy plays an important role in health. The centralised control created problem in managing emergencies. It was also found that the lower level officials need to be part of the planning process as the policies have to be customised.