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151. Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India

Author:
Jishnu Das, Alaka Holla, Aakash Mohpal, and Karthik Muralidharan
Publication Date:
02-2015
Content Type:
Working Paper
Institution:
Centre for Policy Research, India
Abstract:
We present among the first direct evidence on the quality of healthcare in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly-representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. We report three main findings. First, private providers are mostly unqualified but spent more time with patients, and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, we identify the private practices of qualified public sector doctors, and show that the same doctors exert higher effort and are more likely to provide correct treatment in their private practices. Third, we find a strong positive correlation between provider effort and prices charged in the private sector, whereas we find no correlation between effort and wages in the public sector. Our results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low in both the public and private sectors, these differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.
Topic:
Government, Health, Privatization, Health Care Policy, Social Policy, and Rural
Political Geography:
South Asia, India, and Asia

152. India’s Sustainable Development Led Approach to Climate Mitigation for Paris

Author:
Navroz K. Dubash
Publication Date:
08-2015
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
What should India put forward as the mitigation component of its climate contribution? India has dual interests in climate negotiations: safeguarding adequate energy for development, and promoting an effective international agreement to limit its climate vulnerability. To balance these interests, India should pledge well-developed sector-specific actions that maximize synergies across development and climate outcomes. This approach will avoid lock-in to a high carbon growth path while enhancing development. Sectoral actions could include an additional component conditional on availability of international climate finance. In addition, an updated emissions intensity target would serve as a useful complement to sectorally focused action.
Topic:
Climate Change, Development, Energy Policy, and Treaties and Agreements
Political Geography:
South Asia, India, and Global Focus

153. Physician Shortages in the Indian Public Sector

Author:
Anjali Chikersal
Publication Date:
06-2015
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
India is one of the few countries that has been estimated to have a “critical” shortage of health workers and therefore unlikely to be able to provide essential health interventions to its people (WHO 2006). The dire impacts of these shortages are evident from the fact that it has fallen short of meeting its MDG goals on several fronts. As the current discourse on Universal Health Care debates the means of expanding coverage to all citizens, the one aspect universally agreed upon is the persistent challenge that a shortage of health workforce in the public sector poses, and the pressing need to address this gap. This policy brief outlines the core issues at the root of the problem and examines the reasons for the severe shortages in the key element of this workforce, the physicians, in the Indian public sector. It then provides an overview of WHO’s Global Policy Recommendations to address this challenge and looks at the strategies that various Indian states have so far adopted. Finally, it offers a set of practical and goal oriented recommendations aimed at directly and urgently addressing the challenge in the Indian context.
Topic:
Health, Governance, Health Care Policy, Public Policy, and Public Sector
Political Geography:
South Asia and India

154. The Curious Case of GDP Growth

Author:
Rajiv Kumar and Geetima Das Krishna
Publication Date:
05-2015
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
The Central Statistics Office (CSO), the custodian of Indian statistics, has faced a lot of questioning after the release of the new GDP series with 2011-12 as base. The RBI, Ministry of Finance, IMF, several credit rating agencies have all questioned the validity of the revisions. Some analysts like Ruchir Sharma of Morgan Stanley have gone as far as to assert that these revisions if not corrected will make Indian statics as suspect as Chinese GDP data in the past. This will be a real pity. The extent of the revisions is shown in Table 1 below. With the new base year of 2012-13, GDP growth in FY 14 (2013-14) has been revised upwards to 6.6% at factor cost and a whopping 6.9% at market prices. This represents about 2% increase in GDP growth over the earlier estimate of 5%. Surely, such a large scale revision will or should significantly affect the understanding of the underlying economic phenomenon and lead to a marked policy shift. Contrary to what Surjit S Bhalla (SSB) would have us believe, not even the government is taking the revised estimates seriously enough as reflected in a lack of any change in policy direction.
Topic:
Political Economy, GDP, Economy, and Economic growth
Political Geography:
South Asia and India

155. Macroeconomic Update: Early Signs of Rise in Investment

Author:
Geetima Das Krishna and Rajiv Kumar
Publication Date:
07-2015
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
Economic recovery remains fragile on the back of a weak consumption demand. Sustained high growth will be achieved only with an upturn in the investment cycle. The government seems to have understood the importance of pump-priming the capex cycle directly through higher public capital expenditure and front loading the expenditure. While private investment remains muted due to stressed corporate balance sheets, weak external and domestic demand prospects and commercial banks’ cautious approach to expanding credit, there are some early signs that the private investment cycle is likely to turn around in the next six to nine months.
Topic:
Government, Economic growth, Banks, Investment, and Macroeconomics
Political Geography:
South Asia, India, and Asia

156. Macroeconomic Update: Indian Exports: Loss of Global Competitiveness

Author:
Rajiv Kumar and Geetima Das Krishna
Publication Date:
06-2015
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
India’s exports have declined for six consecutive monthssince December 2014 with an average decline of 13.85% yoy. The decline was broad-based. Even exports of Manufactured goods trended lower during this time and failed to compensate for the fall in nominal value of commodity exports, which declined due to a huge erosion of global commodity and oil prices. India’s exports seem to have become more reliant on global commodity prices in recent years. In line with global crude oil prices, India’s monthly petroleum exports that peaked in July’14 at $7 billion shrunk to mere $2.4 billion in May 2015, declining at an average of 52% since the start of the year. Iron ore exports having peaked at $509.5 million in December 2011 moved from $129.5 million in April 2014 to $10 million in May 2015. It is instructive to take a longer term perspective of export performance (Please see Chart I below). Average export growth hasremained almoststagnantsince January 2012 after a sharp bounce back from the collapse in the first and second quarters of 2009, induced by the global financial crisis. Export growth since October 2011 (50 months) is much lower than the robust 20% average clocked during the seven year period of April 2002- March 2009. (marginally lower than the 23% rate of growth assumed for the five year period of 2015-16 to 2020-21 in the Foreign Trade Policy announced in early 2015).
Topic:
International Trade and Finance, Oil, Economic growth, Commodities, Exports, and Macroeconomics
Political Geography:
South Asia, India, and Global Markets