Indian Institute of Public Health Gandhinagar (IIPHG), Opposite Airforce Head Quartes, Gandhinagar, Gujarat 382042, India.
Faculty of Law and Business, Peter Faber Business School, Australian Catholic University, Tenison Woods House, 8-20 Napier Street, North Sydney, NSW 2060, Australia.
Health Policy Plan. 2023 Nov 28;38(10):1121-1130. doi: 10.1093/heapol/czad031.
Posting and Transfer (PT) refers to deployment of the health workforce in ways that ensure appropriate numbers and distribution. Although PT is a crucial aspect of health workforce governance, it remains under-researched from the viewpoint of implementation, health workforce and governance. The aim of this paper is to examine public sector doctors' experience of their initial postings, in the context of local policy from two Indian states. We carried out a review search for policy documentation. A total 61 in-depth interviews were conducted in both states with 33 doctors, as subjects of the study. There were 28 key informant (KI) interviews of health administrators and other policy actors to understand their perspectives of PT policies and implementation. Thematic analysis was used to analyse data. Job histories were constructed from the doctors' interviews to track their experience with the PT system, and analysed using location, duration and postings. Despite search for state policy for PT, we were unable to identify any policy documentation. However, participants referred to PT practices that suggested expectations of what the poliy meant to them. These expectations were corroborated by KI, and the job histories and interview data enabled the authors to construct a series of norms, interpreted as evidence of implied policy. The main norms identified relate to service need, native place, request, gender and posting duration. The norm related to state need had strong face validity, while other norms based on request, gender and duration were less consistent in application. In the absence of documented policies, the construction of norms from the qualitative data proved useful to examine the dynamics of health workers' interactions with the initial PT systems This construction of norms provides a methodological innovation allowing health policy and systems researchers to compensate for the absence of documented policy in exploring PT functions.
调配（PT）是指以确保适当数量和分布的方式部署卫生人力。尽管 PT 是卫生人力治理的一个关键方面，但从实施、卫生人力和治理的角度来看，它仍然研究不足。本文的目的是从印度两个邦的地方政策角度，考察公共部门医生对其最初岗位的体验。我们对政策文件进行了综述搜索。在这两个邦，共对 33 名医生进行了 61 次深入访谈，并将他们作为研究对象。对卫生行政人员和其他政策行为者进行了 28 次关键知情人（KI）访谈，以了解他们对 PT 政策和实施的看法。使用主题分析对数据进行分析。从医生的访谈中构建了他们的工作经历，以跟踪他们在 PT 系统中的经历，并使用地点、持续时间和职位进行分析。尽管我们搜索了有关 PT 的州政策，但我们无法找到任何政策文件。然而，参与者提到了 PT 实践，这些实践表明了他们对政策的期望。这些期望得到了 KI 的证实，工作经历和访谈数据使作者能够构建一系列规范，这些规范被解释为隐含政策的证据。确定的主要规范与服务需求、原籍地、请求、性别和职位持续时间有关。与州需求相关的规范具有很强的表面有效性，而基于请求、性别和持续时间的其他规范在应用中则不太一致。在没有文件政策的情况下，从定性数据构建规范证明有助于检查卫生工作者与初始 PT 系统互动的动态。这种规范的构建为卫生政策和系统研究人员提供了一种方法创新，允许他们在探索 PT 功能时弥补文件政策的缺失。
