The article addresses the HR challenges in successfully evolving and implementing new forms of management support systems being tried out in public systems and identifies a number of HR issues, including attracting and retaining talent for the temporary programme management units. 

 

 

Venkatesh Srinivasan, Assistant Representative India with United Nations Population Fund, has rich consulting, evaluating and monitoring experience in international projects. He can be reached at srinivasan@unfpa.org  

 

 

Improving functioning of public systems has been a topic engaging the attention of public administrators at various levels, administrative reforms committees and academics. The focus of this article is not to reflect on the Human Resource (HR) issues that concern the overall functioning of public systems but to narrow down the discussion to new forms of management support systems that are being tried out to augment the larger public system. Within this realm, this article attempts to highlight the emerging issues in managing human resources that are being laterally infused into the public health system in many states and at the national level. 

 

The current political dispensation at the central level, on its assuming office placed a high emphasis on improving the social sector programmes of the county, with a commitment to enlarge the funding to education, health and allied sectors. The central government committed to increasing the funding for health programmes from a meager 0.9% of the GDP to 2-3% over the next five years. 

 

This political commitment was translated into launching the National Rural Health Mission (NRHM) with the goals of improving the health indicators in the country. The NRHM is also visualized with an special focus on states that have been lagging behind on health parameters and the programme places emphasis on decentralized planning of programmes at the district and lower levels, involvement of private sector with the public systems in increasing the reach and quality of services and increasing investments in augmenting the infrastructure and enhancing the capacities in the systems to effectively implement programmes. The NRHM funding is in the range Rs 7,000 crore a year which translates into almost doubling of funds available to each district. The other departure of the NRHM is to earmark about 70% of the funds for use at the district and subdistrict level, which brings along with it challenges of implementation of the programme at these levels. 

 

Considering, the complexity of the programme and the capacities of the existing systems at the State and District levels, NRHM identified strengthening the functions of programme implementation and financial management. This is expected to augment capacities in planning, implementation, strengthening partnerships with NGOs and the private sector and in improved monitoring of the programme. The financial functions related to improved budgeting, timely release of funds, use of professional accounting practices, auditing and strengthening of financial systems at different levels are expected to be improved. To achieve these objectives, flexible systems such as establishment of state and district health societies have been created. 

 

 

Establishing Programme Management Teams (PMUs) 

 

These societies are empowered to establish Programme Management Units (PMU) with professionals in management, finance and IT. These professionals are hired by the PMU and are awarded annual contracts, with the possibility of renewal based on performance, and are to be working with the senior government officials heading the societies. Many of the state governments have established these PMUs. 

 

 

Attracting and Retaining Talent 

 

The major challenge is to attract professional talent for these assignments. Subsequently success lies in utilizing them fruitfully and to retain them in the PMUs. In addition, the effective functioning of the PMUs depends on various organizational and HR issues. 

 

First and foremost is the clear definition of structural linkages and reporting of the PMU staff with the larger health systems and the precise definition of the responsibilities and tasks. 

 

This is a critical aspect that has been well undertaken as this could snowball into either ineffective use of the professionals or leading to disillusionment among them leading to high levels of attrition. Given the fact that the government functionaries have short tenures in their postings the functioning of the Societies have to be defined precisely and to make amends at regular intervals to address issues that arise. Considering that the PMUs are engaging professionals, one of the key tasks is to define the tasks so that there is objectivity while developing annual work plans and to specify the ways of measuring the work at six monthly intervals. Performance measurement is a very important aspect as their contracts have to be extended based on annual performance. 

 

This entails definition of parameters that could be objectively defined and measured. Most importantly defining them at the start of the year with assessment at regular intervals will bring in objectivity in the work of the professionals and reduce the ambiguity in measuring the performance which could become a major area of contention between the PMU professionals and the government officials resulting in vitiated working environment. 

 

 

Inducting the New Recruits 

 

Another aspect that would contribute to the effecting functioning of the PMU professionals is their proper induction into the government systems and to create a good working environment. As most of the professionals would not be from a public health background a well designed induction programme should be offered at the time of their joining the PMU. Systems of e-learning should also be initiated so that those who may not have the opportunity for undergoing a class room based induction could get an opportunity to learn on their own. 

 

For this to be successful a suitable mentoring system by identified senior officials could be evolved.

 

 

 

Performance Assessment 

 

Objective performance assessment is a key to rewarding the work of the professionals. The first step is to define the work in precisely that was discussed earlier. The others are ensuring definition of process and time lines. A performance appraisal process with definition of the first and second supervisors, the time schedule for the appraisal to be conducted and most importantly adhering to these schedules is critical. 

 

 

 

Grievance Redressal 

 

As the professionals are contractual employees, it would be worth while to bring in practices of having an ombudsman for redressal of HR problems and to have a assessment panel with nominees from outside the health system or from academia. 

This should be considered to bring in objectivity into the performance assessment processes. The debate on improving management of public systems revolves around bringing accountability among government officials. The establishment of PMUs provides a good opportunity for initiating more professional HR practices before they could be tried in the larger government system. 

 

 

Skill Upgradation 

 

As the PMU professionals bring together a specialized set of skills which would be useful for improving the management of programmes. However, these professionals may not be fully conversant with the technicalities of public health programmes. Investment in upgrading skills of PMU professionals in deficit areas should be seen as an investment which could improve their contribution to improved management of the government programmes. 

 

 

 

Compensation and Norms 

 

As government systems are trying out new management systems such as the induction of PMU professionals to improve performance, care should be taken to define the entitlements of the professionals, apart from the monthly remuneration, in travel norms, leave and medical reimbursements. There is a wide body of knowledge in the country in the private sector which also have dual systems of longer tenure professionals and those outsourced; that should form the basis of benchmarking emoluments for the PMU professionals. 

 

 

From the above description of developments in the public health system in the country it is evident that with increased political commitment to improving health outcomes, higher financial flows to the sector and with the government embarking on a path of infusing professional talent into improving programme management, there are a host of HR management issues to grapple with. 

 

Precise definition of the responsibilities and tasks of PMU professionals and their linkages with the larger health system, their proper induction and regular training, establishing clear and well defined performance appraisal systems are critical. For all of these to be accomplished, in the short term, the government could take recourse to contracting HR professionals to be undertaking these tasks or outsource these tasks to an agency. However, if the government would consider using professionals with shorter term contracts and not to hire them as government servants, there is a need for reorganization among government departments to move further from undertaking personnel management to handling a host of HR functions, especially for short term professionals. 

 

The newer approach of establishing PMUs is becoming more of a norm in most government departments and this beckons taking a more professional view of using short term professional and establishing appropriate HR systems. 

 

 

 

 

 

References 

 

 

Agrawal, D. Health sector reforms: relevance in India, Indian Journal of Community Medicine, 31(4), Oct-Dec, 2006. 

Challenges, Vikalpa, July -September, 

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Healthcare Sector Reforms: HR 

Issues and Concerns ... and Future http://indiaimage.nic.in/pmcouncils/ reports/health/health-chap8.htm, retrieved on 15th April 2007. 

http://pmindia.nic.in/speech/ content.asp?id=304, retrieved on 15th April 2007. 

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2007. www.iimahd.ernet.in/faculty/ facultydetails.php?id=216, retrieved on 15th April 2007.