Suchergebnisse

The governments of developing countries, including India, are pursuing policy mixes in collaboration with the private sector to strengthen the public health system. However, little is known about the interaction of public policies with different instrument logics. We conducted a contextual analysis of two health policies with different instrument logics—emergency care and social health insurance programme—for over a decade in Kerala, employing primary and secondary data, government reports, newspaper articles, and published and unpublished literature. Our analysis suggests that the competition between policies has led to policies working at crossroads. The low political salience of emergency care has led to the diversion of resources and attention to government health insurance programmes. Thus, emergency care is increasingly facilitated at private facilities, shifting the government's role from service delivery to financing. Our findings also highlight that the interaction effects among health policies receive limited attention among researchers and practitioners. These findings are relevant to countries of similar economies undergoing New Public Management reforms leading to the weakening of the public system in dealing with health functions such as emergency care.

PurposeControlling partner opportunism in public-private partnership (PPP) requires effective adaptation of governance mechanisms over life-cycle. This paper proposes a process framework of effective governance adaptation for controlling partner opportunism in case of PPP.Design/methodology/approachUsing in-depth interview data and extensive secondary data, a comparative case analysis of governance adaptation for controlling partner opportunism in two provinces in the "National Health Insurance Program" in India was conducted. The study uses contextual analysis and critical incident technique to identify the opportunistic behaviors and use processing tracing to map the adaptation of governance mechanisms for effective control of partner opportunism.FindingsThe paper makes several propositions and proposes a three-stage framework for effective governance adaptation for controlling partner opportunism. The study proposes that governance adaptation begins with the iterative process of discovering governance needs, followed by the dynamic interaction between governance mechanisms shaping the adaptation process. The process ends with two-dimensional alignment–alignment of partner's goal and alignment of governance mix with governance needs resulting in effective governance.Research limitations/implicationsThe paper contributes to the existing debates on governance mix and its effectiveness in PPP by proposing two-dimensional alignment for optimal governance adaptation leading to effective PPP governance.Originality/valueExisting research presents contradictory findings about the effectiveness of governance mechanisms to control partner opportunism. The proposed process-view of governance adaptations tries to address this conundrum to some extent.

AbstractMany public sector programs, such as those directed at public health, are often multiagency tasks where structural incongruity in the program design is liable to emerge over time from changing operational requirements. Yet, successful implementation remains possible because of the interactions and relationships between implementation parties that encourage cooperation and collaboration despite incongruence in the program design. We examine how the dynamics of these interparty relationships influence implementation success in a comparative study of India's National Health Insurance Scheme. We find that implementation parties exhibiting support and complementarity in their interactions created a virtuous cycle of continually encouraging better performance and vice versa. Thus, our findings exhibit a distinct functionary role of interparty interactions and relationships for eliciting effective implementation and governance. The analysis also showcases the need for policy makers and policy designers to be cognizant of the inadvertent introduction of structural inconsistencies and veto points into program designs and their potential influence on implementation outcomes.

AbstractIndia's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes.This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget‐financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015–16 budget. Both are voluntary co‐contributory initiatives aimed at providing access to retirement income to low‐income individuals (government co‐contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members.The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance‐based and aims to provide hospital care to low‐income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology‐enabled platforms such as Aadhaar, will be needed.

Social media has been used widelyfor communicating information, awareness, and promote public policies by government agencies. However, limited attention has been paid to the use of social media in improving the design of public policies. This paper explores to what extent citizens' responses/opinions expressed on social media platforms contribute to policy design. The paper analyzes discussion about the 'Ayushman Bharat' scheme on Twitter through social media analytics techniques (e.g., content analytics) and then traces the change in policy design over two years. To validate findings from Twitter data, and assess the evolution in policy design, we conducted in-depth interviews with experts and extensive document analysis. The paper reveals that consistently similar issues were raised by the experts in the past as well as by the citizens in the current scheme. However, over the period, the policy design has not changed significantly. Therefore, despite a strong social media presence, its optimum use to improve policy effectiveness is yet to be achieved. The paper contributes by exploring the role social media can play in the public policy process and policy design in developing countries' contexts and identifies gaps in existing social media strategies of public agencies.

In developing countries, performance measurement systems are widely adopted but understudied. Using a case study approach, we assess performance measurement systems for the timely delivery of public services in Karnataka, India. We identify the gaps and propose a five-stage framework to measure performance as per an 'authentic' performance measurement approach. We demonstrate the usefulness of the proposed framework by comparing performance measured under the existing framework vis-à-vis proposed, using two-year administrative data. The comparative analysis reveals that the present system lacks accuracy, does not pinpoint low-performing services and departments, and misrepresents performance by wrongly aggregating it to create a favorable impression. The study highlights the lack of policy and analytical capacity in analyzing and interpreting performance data, which limits its appropriate use in diagnosing and perforcing performance. The proposed framework can be adapted for use across context and for different dimensions of performance in services delivery.