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Rural doctors made accountable to Panchayat Raj Institutions, Punjab
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Subject Area="Monitoring, evaluation and quality control." Objective="Performance monitoring and community ownership of public health system."
Details for Reform Option "Rural doctors made accountable to Panchayat Raj Institutions, Punjab"

Background: Punjab has 1310 Subsidary Health Centres (SHC) and Rural Dispensaries that are meant to take public health services right up to the doorstep of the rural population. However, SHCs were non-functional due to frequent absenteeism of doctors. Action: To solve this chronic problem of absenteeism Government of Punjab, from 1 June 2006, handed over management of SHCs and Rural Dispensaries to Zila Parishads (ZP). Now it is the local ZP that engages service providers (Doctors) on contract. The ZP fixed output parameters and benchmarks for each activity to be carried out by service providers. These benchmarks were recommended by a committee of the specialist doctors to make doctors accountable. The committee will also review the benchmarks periodically in the context of local area requirements. The service provider doctors, who fail to meet the benchmarks, will have their contract terminated there and then. (Please see the reference section for: Benchmarks for the doctors engaged by the Zila Parishad on service contract). Service provider (Doctor) will get a consolidated amount as remuneration. The State government will provide the amount to the ZP as grant-in-aid. (For detail Please see PROD entry No 193 on: Management of primary level health facilities by PRI, Punjab). Results: So far all the doctors are meeting the benchmarks overwhelmingly. However, it is too early to say how effective the reform is going to be in the long run.

Cost Only guidelines and a government order are needed to implement the benchmark for accountability of performance of the medical service provides. There is no extra cost incurred in the implementation of the reform.
Place 1310 Subsidiary Health Centres in rural Punjab.
Time Frame Six months.

Accountability: performance of the service providers is monitored objectively. Operationalisation: SHCs are made functional by overcoming abseentism among service providers. Decentralisation: monitoring of the performance is decentralised through Panchayat Raj Institution.


Service Provider’s resistance: Service provider may rebel against the imposition of the PRI on them. Expectation: Service providers expect regularisation of their services on the pattern of Government doctors, including Non-Practising Allowance Inadequacy: PRI members feel they lack the capacity and technical expertise to handle the work. Political influence: There is pressure on doctors from local politicians to appoint Paramedics of their choice.


Sensitisation and training of PRI members.

Who needs to be consulted

PRI members.



The more well entrenched the panchayati raj system in the state the more sustainable the reform. Political empowerment of the rural populace is crucial to sustainability.

Chances of Replication

Much depends upon government willingness; in real terms, all it requires are guidelines and a government order.


PRI involvement in the management of rural health facilities may help the government to improve the service delivery, but simultaneously the community should be involved so that a check and balance is maintained against political vested interest.


Submitted By

Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, August, 2006.

Status Active
Reference Files
Benchmarks for SHC Doctors.doc
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