Management matters: the impact of district level management capacity on health outputs.

The district health system (DHS) is the basic management unit of the Indian public health system. The health outcomes of the state are significantly influenced by the performance of the district health system. The DHS is the locus of the interface between the health care delivery system and ‘vertical’ health programmes. These programmes affect the DHS and are in turn affected by the system, so that the programmes and the system both suffer in case of poor performance. The perceived urgency of achieving national health goals, while legitimate, tends to push the DHS towards the sole attainment of programme targets, often at the cost of building sustained management capacity of the general system. Management capacities of the district health team thus are a critical link in achieving the goals of the health system. We propose in this research to investigate whether, and how, a blended and largely in-service training programme for strengthening management capacities of district health team impacts management practices, and subsequently, positively influences the outputs of the DHS. In doing so, we hope to increase our understanding on how such interventions at the district level work (or do not work). This research will further contribute to provide Indian health policy-makers with an evidence base on the impact of such training programmes.