India Health System Performance Assessment

Health System Performance Assessment benchmarks are to be agreed between the community and the health care delivery institution on the basis of independently organised surveys but the actual process of setting up benchmarks in terms of the performance remains unspecified.

Despite its long felt need, there has been very little research on the performance of the health care delivery system in India. There is no system to assess the performance of the system on a regular basis either at the country or state or below state levels. Moreover, little attention appears to have been paid to health system performance assessment in health planning and programming. This is so when it is well known that regular measuring and monitoring of the performance of the health care delivery system can go a long way in improving its performance in terms of the needs effectiveness - reaching the people - and in terms of its capacity efficiency - delivering full spectrum of quality health care services to those who are within the reach of the system. According to the World Health Report 2000, India ranks 112 in terms of the performance of the health care delivery system among the 191 countries of the world (WHO, 2000). Obviously, there is substantial scope for improvement in the performance of the health care delivery system in the country.

This monograph presents detailed analysis of health system performance in India through the primary health care perspective. The primary purpose is to analyse the performance of the health system at national, State and district levels in terms of its efficiency in delivering selected health care interventions, especially, interventions related to women and children and to rank States and districts in terms of the performance of their health system. A health system performance index has been developed for the purpose which is based on inter-district variation in selected output indicators of primary health care services. Outputs of primary health care services are measured in terms of the coverage rate of selected primary health care interventions. Obviously, the higher is the coverage rate, the more efficient is the health system in reaching those who are in need of services and in delivering full spectrum of health care to them.

The monograph is divided into eight chapters including this introduction and the customary epilogue. The next chapter of the monograph presents a brief description of the composition of the health care delivery system in India and its evolution, especially, after independence. The health care delivery system in India is very complex. It includes both formal and a large informal health care system. The complexity of the health care delivery system in the country is a major challenge towards measuring and monitoring the performance of the system. Because of a very large informal health care system that has prevailed in India through times immemorial, measurement of the performance of 10