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Governance of communicable disease control services : a case study and lessons from India


  • Das Gupta, Monica
  • Khaleghian, Peyvand
  • Sarwal, Rakesh


The authors study the impact of governance and administrative factors on communicable disease prevention in the Indian state of Karnataka using survey data from administrators, frontline workers, and elected local representatives. They identify a number of key constraints to the effective management of disease control in India, in misaligned incentives, and the institutional arrangements for service delivery. The authors discuss these under five headings: administrative issues; human resource management; horizontal coordination; decentralization, community involvement, and public accountability; and implementation of public health laws and regulations. They find that India's public health system is configured to be highly effective at top-down reactive work, such as bringing disease outbreaks under control, but not for the more routine collaborations required for proactive disease prevention. The authors conclude with policy recommendations that take into account the complexity of India's system of public administration and the need for simple reforms that can be easily implemented.

Suggested Citation

  • Das Gupta, Monica & Khaleghian, Peyvand & Sarwal, Rakesh, 2003. "Governance of communicable disease control services : a case study and lessons from India," Policy Research Working Paper Series 3100, The World Bank.
  • Handle: RePEc:wbk:wbrwps:3100

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    References listed on IDEAS

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    3. Tendler, Judith & Freedheim, Sara, 1994. "Trust in a rent-seeking world: Health and government transformed in Northeast Brazil," World Development, Elsevier, vol. 22(12), pages 1771-1791, December.
    4. Filmer, Deon & Pritchett, Lant, 1999. "The impact of public spending on health: does money matter?," Social Science & Medicine, Elsevier, vol. 49(10), pages 1309-1323, November.
    5. David H. Peters & Abdo S. Yazbeck & Rashmi R. Sharma & G. N. V. Ramana & Lant H. Pritchett & Adam Wagstaff, 2002. "Better Health Systems for India's Poor : Findings, Analysis, and Options," World Bank Publications, The World Bank, number 14080, June.
    6. McGuire, James W., 2001. "Social Policy and Mortality Decline in East Asia and Latin America," World Development, Elsevier, vol. 29(10), pages 1673-1697, October.
    7. Gauri, Varun & Khaleghian, Peyvand, 2002. "Immunization in Developing Countries: Its Political and Organizational Determinants," World Development, Elsevier, vol. 30(12), pages 2109-2132, December.
    8. McMillan, Della E. & Meltzer, Martin I., 1996. "Vector-borne disease control in sub-Saharan Africa: A necessary but partial vision of development," World Development, Elsevier, vol. 24(3), pages 569-588, March.
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    Cited by:

    1. Das Gupta, Monica, 2005. "Public health in India : an overview," Policy Research Working Paper Series 3787, The World Bank.
    2. Sheikh, Kabir & Porter, John, 2010. "Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing," Social Science & Medicine, Elsevier, vol. 71(11), pages 2005-2013, December.
    3. Guinness, Lorna, 2011. "What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?," Social Science & Medicine, Elsevier, vol. 72(12), pages 1939-1947, June.


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