Analysis and design of public policy using system dynamics approach: a case in healthcare sector.

Abstract

High prevalence of communicable diseases, rapid increase in prevalence of non-communicable diseases, and poor maternal and child health indicators characterize public health situation in India. One of the main reasons for it is inadequate coverage of healthcare services. For inadequate coverage of healthcare services, lack of trained healthcare workforce has been stated as one of the reasons (Koblinsky, Matthews, Hussein, Mavalankar, Mridha, Anwar et al., 2006; Dogba & Fournier, 2009). In India, health is a state government subject. As of now many states in India do not have a clearly formulated health policy. Health policy followed by state governments is generally guided by policy and programs formulated by the central government at the national level. Moreover, provision of healthcare services by public healthcare setups is driven by supply and not by demand for healthcare services (Ramani & Mavalankar, 2006). In such a situation, it becomes necessary to carry out analysis of healthcare workforce policy so as to bridge the gap between demand and supply of healthcare services. In this research work, a System Dynamics model is developed that characterizes decision-making process of estimating demand for healthcare workforce and meeting it through recruitment in public Ayurveda healthcare setup. Public Ayurveda healthcare setup was selected based on the consideration that there is an official policy of promoting traditional system of medicines and its practitioners in providing healthcare services. At the same time, policy formulation for healthcare workforce in these setups is largely ad hoc in nature. The developed model was simulated for a period of 50 years for knowing both short term and long term trends in the setup. Results obtained indicate that current decision-making process is having a significant negative impact on healthcare service provision capacity of the setup. Outputs obtained also highlight the requirement of rapid upscale in healthcare service provision capability of the setup. This study demonstrates the application of System Dynamics methodology for policy analysis and formulation. Key contributions of this study are (a) Providing an integrated tool for analysis of healthcare workforce policy, (b) Informing linkages between existing healthcare workforce policies and their impact on behavior of public healthcare system, and (c) Learning from exploration and generalizing for public policy in a broader context.