In recent years, the governance of the health system has become a key issue of discussion for international organisations such as the WHO, the WB, UNDP, USAID and the EC. Furthermore, they state that spending on health would not alone achieve the intended results in health without addressing governance.
The District Health Administration (DHA), generally called the office of the Civil Surgeon in Bihar, India, is considered a bridging administrative unit from national and state government to the community at village level. Moreover, this is a full-bodied unit with management and the administrative power under the leadership of Chief Medical Officer/Civil Surgeon and Assistant Chief Medical Officer with various health programme officers and support staff. Although health service delivery is seen to have improved in Bihar in recent years, issues such as leadership, management, accountability and transparency would seen to be weak in the DHA.
This study aims to recommend specific strategies to strengthen governance of the DHA in Bihar. In doing so, it first identifies and critically analyses the causes of poor governance of the DHA. Moreover, it reviews theories and documented effective examples of strengthening governance in the district level health systems in low and middle income countries. This study finally analyses various strategies for strengthening governance and outlines appropriate governance for the DHA in Bihar.To undertake this study, a framework for strengthening governance developed by Brinkerhoff et al. (2008) is used, which covers leadership and management capacity, accountability, community participation and transparency in decision making. The methodology primarily involves reviewing secondary data; however, a number of health and development professionals and legal experts were contacted to obtain a number of practical experiences.
Table of Contents
CHAPTER ONE: INTRODUCTION TO DISSERTATION: FRAMEWORK OF STRENGTHENING GOVERNANCE OF HEALTH ADMINISTRATION
1.1 Introduction
1.2 Background and rationale
1.3 Aims and objectives
1.4 Output of the dissertation
1.5 Methodology
1.5.1 Type of dissertation
1.5.2 Search strategy
1.5.3 Sources of data
1.6 Governance and its framework
1.6.1 Definitions of governance
1.6.2 Governance in health sectors
1.6.3 A framework of strengthening governance
1.6.4 Possible effects of good governance of the DHA in Bihar
1.7 Limitations
1.8 Target audience
1.9 Structure of the dissertation
1.10 Summary
CHAPTER TWO: OVERVIEW OF THE STATE, PROBLEMS AND ISSUES OF GOVERNANCE IN THE DHA
2.1 Introduction
2.2 State background
2.3 District health system and its links with PRIs
2.4 Structure and functions of the health department
2.4.1 Organisational structure and functions of the DHA with its links to the department of health and family welfare, Bihar (DHFW)
2.4.2 Major functions of the DHA
2.5 Problem analysis of governance in the District Health Administration
2.5.1 Introduction
2.5.2 Weak leadership capacity
2.5.3 Weak management capacity
2.5.4 Poor accountability to the public
2.5.5 Low Participation of people in decision making and planning
2.5.6 Poor transparency in decision making
2.6 Summary
CHAPTER THREE: STRENGTHENING GOVERNANCE OF HEALTH ADMINISTRATION: THEORIES AND PRACTICAL EXPERIENCES
3.1 Introduction
3.2 Theories and documented examples on governance in health administration
3.2.1 Improving leadership capacity
3.2.2 Improving Management Capacity
3.2.3 Promoting accountability
3.2.4 Increasing community participation in decision making and planning
3.2.5 Ensuring transparency in decision making
3.3 Summary
CHAPTER FOUR: APPLICATION OF THEORIES AND THE PRACTICAL EXPERIENCES IN THE CONTEXT OF BIHAR
4.1 Introduction
4.2 Strengthening governance of the DHA in Bihar
4.2.1 Improving leadership capacity
4.2.1.1 Leadership Style
4.2.1.2 Training on Leadership Building
4.2.2 Improving management capacity
4.2.3 Promoting accountability to people
4.2.4 Community participation in decision making
4.2.5 Transparency in decision making
4.3 Strategy for strengthening governance of the DHA in Bihar
4.4 Summary
CHAPTER FIVE: ISSUES FOR DISSEMINATION AND IMPLEMENTATION OF THE PROPOSED STRATEGIES FOR STRENGTHENING GOVERNANCE OF THE DHA IN BIHAR
5.1 Introduction
5.2 Dissemination of the proposed strategy for strengthening governance in the DHA
5.3 Issues for implementation
5.4 Conclusion
5.5 Reflective notes
Objectives and Scope
This study aims to recommend specific strategies to strengthen the governance of the District Health Administration (DHA) in Bihar, India, by identifying causes of poor governance and reviewing international best practices to propose a framework for improvement.
- Analysis of causes of poor governance in the DHA.
- Review of international theories and practical experiences in health governance.
- Proposal of strategies for leadership and management capacity building.
- Framework for enhancing community participation and transparency in decision-making.
Excerpt from the Book
1.6.3 A framework of strengthening governance
Governance of the DHA can be analysed in a number of ways. The dissertation will particularly focus on the DHA’s system management and its governance, and will not cover service delivery. There may be some overlap in the framework and analysis, as Bossert (2008) argues that the community participation in decision making may influence accountability and transparency in a public institution. Therefore, it can be assumed that intervention in a component of governance may contribute to another.
This study uses a governance framework for strengthening health administration recently developed by Brinkerhoff et al. (2008). It is used to strengthen health systems governance in USAID-supported countries. The framework is as follows:
Leadership Capacity: vision and capacity to guide organisational staff for building collaboration with stakeholders to have a common plan
Management Capacity: capable to manage resources, undertake planning and structure the roles and responsibility of personnel
Accountability: accessibility of reliable information to people and address health needs of the community
Citizen Participation: adequate administrative mechanisms to enable citizen participation in decision making
Transparency: disclose plan and policy documents and information to the public
Chapter Summaries
CHAPTER ONE: INTRODUCTION TO DISSERTATION: FRAMEWORK OF STRENGTHENING GOVERNANCE OF HEALTH ADMINISTRATION: Provides the study background, rationale, and establishes the governance framework used for analysis.
CHAPTER TWO: OVERVIEW OF THE STATE, PROBLEMS AND ISSUES OF GOVERNANCE IN THE DHA: Analyzes the current context of Bihar and identifies specific weaknesses in leadership, management, and accountability within the DHA.
CHAPTER THREE: STRENGTHENING GOVERNANCE OF HEALTH ADMINISTRATION: THEORIES AND PRACTICAL EXPERIENCES: Reviews global theories and documented examples of effective governance in district health systems.
CHAPTER FOUR: APPLICATION OF THEORIES AND THE PRACTICAL EXPERIENCES IN THE CONTEXT OF BIHAR: Outlines specific strategies for improving governance in Bihar based on the reviewed frameworks and local context.
CHAPTER FIVE: ISSUES FOR DISSEMINATION AND IMPLEMENTATION OF THE PROPOSED STRATEGIES FOR STRENGTHENING GOVERNANCE OF THE DHA IN BIHAR: Discusses the practical steps for sharing the findings and implementing proposed changes, including stakeholder roles.
Keywords
Governance, District Health Administration, Bihar, Leadership Capacity, Management Capacity, Accountability, Community Participation, Transparency, Health Policy, Decentralization, Public Health, Health Systems, Capacity Building, Civil Society, Panchayati Raj Institutions
Frequently Asked Questions
What is the primary focus of this research?
The research focuses on strengthening the governance of the District Health Administration (DHA) in Bihar, India, to improve overall health service delivery.
What are the core areas of governance analyzed?
The work examines leadership and management capacity, accountability, community participation in planning, and transparency in decision-making.
What is the research's main objective?
The primary goal is to identify causes of poor governance in the DHA and to recommend actionable strategies for reform.
Which methodology is applied?
The study utilizes secondary data review, situational analysis using a problem tree framework, and a conceptual governance framework developed by Brinkerhoff et al. (2008).
What is covered in the main body?
The body covers a situational analysis of Bihar, a review of international governance theories, an application of these theories to the local context, and a dissemination plan for the proposed strategies.
Which keywords define this work?
Key terms include governance, DHA, accountability, leadership, community participation, transparency, and public health policy.
How does the current policy affect DHA performance?
The current policy focuses overly on clinical care, which undermines administrative governance, leadership development, and effective stakeholder engagement.
Why is community participation currently low in Bihar?
Low participation is attributed to a lack of power devolution to local bodies, political interference, and insufficient awareness of health frameworks among local representatives.
What role does the Right to Information (RTI) act play in the proposed reforms?
The RTI is central to the strategy for increasing transparency and holding the DHA accountable through public disclosure of policies, budgets, and operational performance.
- Quote paper
- Varun Kumar (Author), 2008, Strengthening Governance of District Health Administration , Munich, GRIN Verlag, https://www.hausarbeiten.de/document/157954
