An Assessment of the Functioning of India's Public Health System

Monica Das Gupta, World Bank Group
Manju Rani, Consultant, DECRG, The World Bank

India has relatively poor health outcomes, despite having a well-developed administrative system, excellent technical skills, and an extensive network of public health institutions. This suggests that the health system may be mis-directing its efforts, or be poorly designed. We assess the performance of the Essential Public Health Functions at central government level, using data from senior officials. We find that the strengths of the system lie in its expertise and infrastructure. Weaknesses include overlooking some fundamental public health functions such as public health regulations, and deep management flaws which hinder effective use of resources. The latter include inadequate focus on evaluation; assessing quality of services; dissemination and use of information; openness to learning and innovation; partnerships with others; and providing support to sub-national levels. Resources could be much better utilized with small changes. With some re-assessment of priorities and better management practices, health outcomes could be improved with existing resources.