Garimella Surekha, Sheikh Kabir
Public Health Foundation of India, Gurgaon, Haryana, India.
J Family Med Prim Care. 2016 Jul-Sep;5(3):663-671. doi: 10.4103/2249-4863.197310.
Posting and transfer (PT) of health personnel - placing the right health workers in the right place at the right time - is a core function of any large-scale health service. In the context of government health services, this may be seen as a simple process of bureaucratic governance and implementation of the rule of law. However the literature from India and comparable low and middle-income country health systems suggests that in reality PT is a contested domain, driven by varied expressions of private and public interest throughout the chain of implementation.
To investigate policymaking for PT in the government health sector and implementation of policies as experienced by different health system actors and stakeholders at primary health care level.
We undertook an empirical case study of a PT reform policy at primary health care level in Tamil Nadu State, to understand how different groups of health systems actors experience PT. In-depth qualitative methods were undertaken to study processes of implementation of PT policies enacted through 'counselling' of health workers (individualized consultations to determine postings and transfers).
PT emerges as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. Micro-practices of governance represent homegrown coping mechanisms of health administrators that reconcile public and private interests and sustain basic health system functions. Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. It signifies how well a system treats its employees, and by inference, is an index of the overall health of the system.
For a complex governance function such as PT, the roles of private actors and private interests are not easily separable from the public, but rather are intertwined within the complexities of delivery of a public service. This complexity blurs conventional boundaries of private and public ownership and behaviour, and raises critical questions for the interpretation of coordinated governance. Hence, the imperative of enforcing rules may need to be complemented with bottom-up policy approaches, including treating PT not merely as system dysfunction, but also as a potential instrument of governance innovations, procedural justice and the accountability of health services to communities they seek to serve.
卫生人员的调配与转岗（PT）——在正确的时间将合适的卫生工作者安置在正确的地点——是任何大规模卫生服务的核心职能。在政府卫生服务的背景下，这可能被视为一个简单的官僚治理和法治实施过程。然而，来自印度以及类似的低收入和中等收入国家卫生系统的文献表明，实际上PT是一个存在争议的领域，在整个实施链条中受到各种公私利益表达的驱动。
调查政府卫生部门中PT的政策制定情况，以及初级卫生保健层面不同卫生系统行为者和利益相关者所经历的政策实施情况。
我们对泰米尔纳德邦初级卫生保健层面的一项PT改革政策进行了实证案例研究,以了解不同群体的卫生系统行为者如何体验PT。采用深入的定性方法研究通过对卫生工作者进行“咨询”（为确定调配与转岗而进行的个性化咨询）来实施PT政策的过程。
PT是一个复杂的现象，部分由国家法律塑造，部分是一个平行的规范和激励系统，需要考虑和协调不同群体的利益。微观治理实践代表了卫生管理人员的本土应对机制，这些机制调和了公私利益并维持基本卫生系统功能。除了PT的功能视角外，它还反映了卫生系统中体现的正义和公平。它表明一个系统如何对待其员工，由此推断，它是该系统整体健康状况的一个指标。
对于PT这样复杂的治理职能，私人行为者和私人利益的作用与公共行为者和利益并非易于区分，而是在公共服务提供的复杂性中相互交织。这种复杂性模糊了公私所有权和行为的传统界限，并对协调治理的解释提出了关键问题。因此，执行规则的必要性可能需要辅之以自下而上的政策方法，包括不仅将PT视为系统功能失调，而且将其视为治理创新、程序正义以及卫生服务对其服务社区负责的潜在工具。
