Jeffrey Hammer

The authors show how the recent empirical and theoretical literature on health policy sheds light on the disappointing experience with the implementation of primary health care. They emphasize the evidence on two weak links between government spending on health and improvements in health status. First, the capability of developing country governments to provide effective services varies widely -- so health spending, even on the"right"services, may lead to little actual provision of services. Read more »

The quality of medical care received by patients varies for two reasons: Differences in doctors’ competence or differences in doctors’ incentives. Using medical vignettes, we evaluated competence for a sample of doctors in Delhi. One month later, we observed the same doctors in their practice. We find three patterns in the data. First, what doctors do is less than what they know they should do–doctors operate well inside their knowledge frontier. Second, competence and effort are complementary so that doctors who know more also do more. Read more »

The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. We address this gap through a survey in Delhi with two related components. We evaluate “competence” (what providers know) through vignettes and practice (what providers do) through direct clinical observation. Read more »

This paper aims to develop an analytical framework within which to understand the status of health care in India. Drawing on a model of public sector accountability, it argues that weak voice and low accountability between public sector employees and citizens in the health care sector is the key binding constraint to effective delivery.

India is currently witness to two trends that have the potential to significantly improve the health of its people. The first is the growing recognition that the system of public delivery of health services is in crisis. And the second is India’s bold efforts to strengthen the voice of the rural poor through decentralization to local governments.This paper argues that these two ostensibly separate trends can converge to generate real reform in the health sector in India through the potential for increased accountability that local governments can provide. Read more »