Goal-setting in health services in India: Why it does not work?

There are several instances where specific targeted programmes and goals have wrecked havoc with the health services system in the country. After the family planning programme and the small-pox eradication drive, the recent case of such diversion happened due to the pulse-polio programme. Objectives: 1. This paper discusses the goal setting process with regard to four major policies/Strategies/programs after independence such as the visions of the first committee on health, the family planning programme, Health For All strategies and the RCH program. 2. It analyzes the reasons for the failures in achieving the goals with regard to the above programs. Findings: The history of goal-setting in India provides some valuable lessons for the health services development in the country. This suggests that the whole process of goal-setting has to be re-examined. The process has to be realistic based on the epidemiological pattern and the natural history of any specific problem. The reasons for the under achievements in programs evident from the above examples could be multi-dimensional. It indicates organizational weaknesses not just at the time of implementation as is often pointed out but even at the time of planning and programming itself. Failure in implementation could be the result of unrealism and lack of vision at the planning stage. Conclusions: The evidence shows that the complexity of the problem cannot be tackled by targeted interventions based on aggregate data as targeted interventions could lead to techno-centric packages ignoring the larger structural dimensions of the problem. The target-driven programs can also result in intensive, vertical and categorical programs which may distort the comprehensiveness of health services as has happened with the attempt to eradicate polio. The target driven and time-bound approaches could also place unrealistic demands on the existing fragile and crumbling delivery systems in the developing countries.