Management of Resource Dependency : Key to Implementation of Health Care Programmes: Insights from India

A population's health is a critical input for its economic growth. Although improvements in medical technology and spread of education have resulted in improvement in health indices, disparities in their distribution are starkly prevalent. These inequalities, result of poor utilisation of available interventions, need to be addressed as they impede economic growth. This would necessitate a persistent focus on management of implementation of health care interventions, aided by a dominant operational framework. Implementation literature is handicapped by lack of such a dominant framework and aggregated theory which could have guided practioners towards effective implementation. This paper attempts to address this felt need. Using a multiple embedded case processual study with interlinked multiple units of analysis; it studies the implementation of four national health programmes in three states of India. Positioned in the rural health context, it identifies effective implementation to be a function of management of resource dependency of a programme and cumulatively of the health system. Management of resource dependency is driven by identification of “Key resources” critical for service delivery under a programme. Effective implementation is achieved by the attention of the top management in identifying these Key resources, directing the system processes to generate, distribute and position resources and finally governance of the service delivery actions. Thus implementation is a function of attention, direction and governance. This operational framework, based on observable actions in the field, has significant implications for both practioners and researchers alike. It gives a framework to facilitate better implementation of health care interventions and hence address issues of health disparities. For researchers it generates a tentative mid range theory to act as a base for future research