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Community Action for Health in India's National Rural Health Mission: One policy, many paths
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7234-3510
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7087-1467
2017 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 188, p. 82-90Article in journal (Refereed) Published
Abstract [en]

Community participation as a strategy for health system strengthening and accountability is an almost ubiquitous policy prescription. In 2005, with the election of a new Government in India, the National Rural Health Mission was launched. This was aimed at 'architectural correction' of the health care system, and enshrined 'communitization' as one of its pillars. The mission also provided unique policy spaces and opportunity structures that enabled civil society groups to attempt to bring on to the policy agenda as well as implement a more collective action and social justice based approach to community based accountability. Despite receiving a lot of support and funding from the central ministry in the pilot phase, the subsequent roll out of the process, led in the post-pilot phase by the individual state governments, showed very varied outcomes. This paper using both documentary and interview based data is the first study to document the roll out of this ambitious process. Looking critically at what varied and why, the paper attempts to derive lessons for future implementation of such contested concepts.

Place, publisher, year, edition, pages
2017. Vol. 188, p. 82-90
Keywords [en]
Community action for health, National Rural Health Mission India, Policy implementation, Community participation, India
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-138466DOI: 10.1016/j.socscimed.2017.06.043ISI: 000408783400009PubMedID: 28732238OAI: oai:DiVA.org:umu-138466DiVA, id: diva2:1135575
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2020-02-04Bibliographically approved
In thesis
1. Divergences, dissonances and disconnects: implementation of community-based accountability in India’s national rural health mission
Open this publication in new window or tab >>Divergences, dissonances and disconnects: implementation of community-based accountability in India’s national rural health mission
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Accountability of health systems to the individuals and communities they serve is increasingly recognized as a key aspect in efforts at health system strengthening. This has led to a greater focus on efforts to evolve systems that enable communities to hold health systems accountable. In parallel with this change, the governance of public systems has been transformed under the influence of the neo-liberal paradigm of governance. India introduced the flagship National Rural Health Mission (presently termed the National Health Mission) in 2005, to bring about an architectural correction of the health system. One of the five key components of the mission was ‘Communitization’. This component aimed to increase the ownership of the health systems by the communities they serve. As part of this a programme called Community Action for Health (CAH) was piloted in nine states and then rolled out nationally. The implementation diverged from the originally envisaged process in different states.

This PhD research aims to understand the institutional level influences that impact on the implementation of community-based accountability and governance mechanisms and the potential of integrating such processes in the public health system in India. I used qualitative methods to map out the divergences in implementation and sought to understand the reasons for these. Next, I conducted a case study of the southern state of Tamil Nadu, in which I focused on the processes within the apex administrative level of the state.

In addition to mapping two dimensions along which the policy seemed to diverge, I also documented three distinct perspectives on accountability among the key actors involved in implementing CAH. Overall there were three constructs that emerged from the research: ‘Divergences’, ‘Dissonances’ and ‘Disconnects’. Divergences refer to the way in which policies and programmes shift from the original conceptualization. Dissonances points to the presence of multiple perspectives on the same concept in the same organizational setting. Disconnects represents the lack of spaces within the organization that enable processes of collective sensemaking. The emergent understanding from the research is that the divergences in policy implementation may in fact reflect a deeper level of conflict at the level of belief and perspectives in different layers of the administration. In the absence of spaces and processes to facilitate collective sense-making, it is likely that policies, even when introduced with significant commitment from policymakers at the higher administrative layers, are likely to require systematic effort to sustain.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2020. p. 79
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2071
Keywords
Community Action for Health, Community-based Accountability, Policy Implementation, Problematization, Institutional Perspective, National Rural Health Mission / National Health Mission, Tamil Nadu, India
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-167590 (URN)978-91-7855-204-7 (ISBN)978-91-7855-205-4 (ISBN)
Public defence
2020-02-28, N440, Naturvetarhuset, Umeå universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2020-02-07 Created: 2020-01-31 Last updated: 2020-02-07Bibliographically approved

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