Peter Faber Business School, Australian Catholic University, Building 532-Tenison Woods House, 8-20 Napier Street, North Sydney, New South Wales 2060, Australia.
Department of Health Policy and Management, Indian Institute of Public Health Gandhinagar (IIPHG), NH-147, Palaj Village, opp. New Air Force Station HQ, Gandhinagar, Gujarat 382042, India.
Health Policy Plan. 2024 Nov 14;39(10):1055-1064. doi: 10.1093/heapol/czae085.
The deployment of the health workforce, carried out through initial and subsequent posting and transfer (PT), is a key element of health workforce management. However, the focus of the currently available PT literature is mostly on subsequent PT, and the distinction between initial and subsequent PT has received little research attention. Drawing on this gap, in this paper, we examine how doctors experience their subsequent PT compared with their initial postings in two states in India. The distinctions have been drawn using the prism of six norms that we developed as evidence for implied policy in the absence of documented policy. This mixed-methods study used in-depth interviews of doctors and key informants, with job histories providing quantitative data from their accounts of their PT experience. Based on the interviews of these frontline doctors and other key policy actors, this paper brings to light key differences between initial and subsequent postings as perceived by the doctors: compared with initial postings, where the State demands to meet service needs dominated, in subsequent postings, doctors exercised greater agency in determining outcomes, with native place a central preoccupation in their choices. Our analysis provides a nuanced understanding of PT environment through this shift in doctors' perceptions of their own position and power within the system, with a significant change in the behaviour of doctors in subsequent PT compared with their initial postings. The paper brings to light the changing behaviour of doctors with subsequent PT, providing a deeper understanding of PT environment, expanding the notion of PT beyond the simple dichotomy between service needs and doctors' requests.
卫生人力的部署是通过初始和后续的派遣和调配（PT）来实现的，这是卫生人力管理的关键要素。然而，目前关于 PT 的文献主要集中在后续 PT 上，初始和后续 PT 之间的区别很少受到关注。针对这一差距，本文在印度的两个邦中，考察了医生在初始派遣和后续派遣中的经历有何不同。我们使用了六个规范来进行区分，这些规范是作为没有文件记录的政策的隐含政策的证据而制定的。这项混合方法研究使用了对医生和关键信息者的深入访谈，以及工作经历提供的有关他们 PT 经历的定量数据。基于对这些一线医生和其他关键政策参与者的访谈，本文揭示了医生所感知的初始和后续派遣之间的关键差异：与初始派遣相比，在初始派遣中，国家要求满足服务需求占据主导地位，而在后续派遣中，医生在决定结果方面拥有更大的自主权，出生地是他们选择的核心关注点。通过医生对自己在系统中的地位和权力的看法的转变，我们对 PT 环境进行了细致的分析，与初始派遣相比，医生在后续派遣中的行为发生了显著变化。本文揭示了医生在后续派遣中的行为变化，更深入地了解了 PT 环境，将 PT 的概念扩展到了服务需求和医生请求之间的简单二分法之外。
