PhD Confirmation - Prarthna Dayal
Understanding the response of public hospitals to reform initiatives in India: A Case study of the Pradhan Mantri Jan Arogya Yojana
Prarthna has been working with the Nossal Institute since 2008 and has managed a portfolio of work in South Asia and provided technical assistance and research in building better health systems for maternal, newborn and child health. She coordinated the International Child Health subject for the Master of Public Health at the University of Melbourne from 2014-2020. She has an MA in International Relations and Economics from the Johns Hopkins University School of Advanced International Studies and a BA in Economics (Honours) from Lewis & Clark College, USA.
In India, the poor disproportionately depend on public hospitals for healthcare and public hospitals absorb the lion’s share of government funding on health. Yet their performance remains sub-optimal and the quality of care they provide remains patchy at best. Successive attempts at reforming India’s public health system have fallen short. While these failures are well-documented, and there is some recognition that these failures are disproportionately related to the ‘implementation’ of these initiatives, there is little research on what might be constraining the day-to-day implementation of such reform initiatives.
In 2018, India launched another major publicly funded initiative whose explicit aim is to provide health related financial risk protection to the poor - its tacit aim includes influencing the functioning of public hospitals. The initiative is called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) – and both private and public hospitals can receive financing through the initiative. Emerging evidence however points to a rather unenthusiastic response to the initiative from public hospitals in many states. For instance, in Uttar Pradesh (India’s largest state with a population of 220 million), of all the disbursements under the initiative, only 20.8% have been towards public hospitals.
My research project will use PMJAY as a case study to better understand what shapes public hospitals’ response to initiatives that are aimed at improving their functioning. My inquiry will be informed by theoretical insights from sociology and economics. The focus of the inquiry would be to understand the institutional arrangements, processes and organizational cultures that enable or constrain public hospital’s mobilization, absorption and use of resources and opportunities offered by the PMJAY initiative in the state of Uttar Pradesh.
Supervisors:
- Primary supervisor: Barbara McPake
- Co-supervisors: Sumit Kane and Alison Morgan
- Chair of Advisory Committee: Peter Annear