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Consensus and conflicts in health sector reforms in India: a Delphi study
K Anand1, C S Pandav, S K Kapoor
1All India Institute of Medical Sciences, Ansari Nagar, New Delhi. crhspaiims@sancharnet.in
The National Medical Journal of India
|September 26, 2002
Summary
This Delphi study assessed consensus on Indian health policy, identifying primary healthcare quality, medical education, and disease surveillance as top priorities. The method proved feasible for evaluating health policy issues and achieving broader system buy-in.
Area of Science:
- Public Health
- Health Policy Research
- Healthcare Management
Background:
- Health sector reforms in India are a subject of significant debate, particularly post-economic liberalization.
- The World Bank's 1993 redefinition of public and private healthcare roles intensified discussions.
- A formal assessment of consensus and conflicts in health policy issues was lacking prior to this study.
Purpose of the Study:
- To formally assess consensus and identify conflicts regarding health policy issues in India.
- To evaluate the feasibility of a Delphi study for health policy consensus-building.
- To inform the National Health Policy through a structured expert opinion gathering process.
Main Methods:
- A 9-domain, 56-item questionnaire was developed based on literature review.
- A Delphi study was conducted with 132 diverse respondents, from grassroots workers to policymakers.
- Consensus was defined as >=75% agreement; conflict as >35% on either side of a divide.
Main Results:
- Key priorities identified and ratified: improving primary healthcare quality, enhancing medical education, and establishing disease surveillance.
- Areas of consensus included: formalizing public-private health sector interaction, implementing cost recovery, establishing a technology assessment commission, and ensuring accountability.
- Conflicts arose regarding medical education subsidies, health insurance roles, and the integration of health professionals with local governance (Panchayati Raj institutions).
Conclusions:
- The Delphi approach is a feasible, cost-effective method for assessing health policy consensus on a large scale.
- This method broadens involvement and can lead to greater self-involvement in decision-making.
- Wider involvement and self-involvement are likely to reduce resistance during policy implementation.