Rural Health Innovation through Leadership Development and Organisational Effectiveness

Improving rural health service delivery is a major challenge in India as 73 percent of its population resides in rural areas. Recognizing the need to improve rural health service delivery, the Government of India launched the National Rural Health Mission (NRHM) in 2005. The NRHM aims to undertake architectural correction of the rural health system through communitization, improved management, flexible financing, innovations in human resource management, and strengthened monitoring against standards.This paper describes an innovative leadership development and organizational effectiveness intervention for district health teams comprising district and block (sub-district) level health officials in three districts of Jharkhand, a state with low socio-economic conditions. The intervention over a period of three years comprised of a sequence of short-term training programmes in leadership and organizational effectiveness with on-the-job support through follow-up between training programmes. The intervention led to increased focus on health system performance by the district health teams in these districts although the results varied.The district health teams strengthened public-private partnerships, accelerated communitization process, improved functionality of facilities, and demonstrated role models. However, several factors also limited the potential impact of the intervention. These include serious human resource constraints, frequent transfers of district heads, procedural hurdles in funds flow from state to districts and quality of governance. Despite these constraints, leadership development and organizational effectiveness intervention is an effective instrument for strengthening rural health system. The paper presents recommendations on how its impact can be further increased.