Scaling Up Primary Health Services in Rural India

Abstract

We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services (in Uttar Pradesh, and Madhya Pradesh) in the area of primary health, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of these two states? And 2) what policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely setting up more health clinics, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example. Nirupam Bajpai is Senior Development Advisor and Director of the South Asia Program at CGSD. He is also a member of the UN Millennium Project. Ravindra H. Dholakia is Professor of Economics at the Indian Institute of Management at Ahmedabad in India. Jeffrey D. Sachs is Director of the Earth Institute at Columbia University and Special Advisor to the United Nations Secretary General, Kofi Annan. During the week of November 14, 2005, Nirupam Bajpai submitted this paper to His Excellency, Dr. A P J Abdul Kalam, President of India and the Honorable Dr. Manmohan Singh, Prime Minister of India. Nirupam Bajpai also presented and discussed this paper with Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning Commission, Digvijaya Singh, General Secretary, All India Congress Committee and former Chief Minister of Madhya Pradesh, Babulal Gaur, Chief Minister of Madhya Pradesh, Mulayam Singh Yadav, Chief Minister of Uttar Pradesh, Vijay Singh, Chief Secretary of Madhya Pradesh and R Ramani, Chief Secretary of Uttar Pradesh and several other senior civil servants in Delhi, Bhopal and Lucknow.