The result section is organised into four examples that demonstrate interactions, experiences, conflicts and policy implementation gaps in relation to three Human Resource Management (HRM) systems: recruitment, first posting and subsequent Posting & Transfer (P&T). For the purposes of this paper, to demonstrate the variations possible within the data, we have purposively selected different sets of job histories from the two sites. The examples are not contiguous with each other and do not represent our complete findings.
Example 1: What is recruitment in public sector and how long does it take?
Health is a state responsibility in India, and each state has Public Service Commission (PSC) that is responsible for recruitment of permanent government employees. Recruitment through the PSC is very important to the employee, as it represents the official starting point of permanent service with the government. Employment and work experience with the health department prior to PSC recruitment (often under contractual, temporary or ad-hoc appointment) does not count towards any service related benefits like pension, promotions etc. Doctors appointed under contractual category are required to pass the PSC exam during their service, and PSC recruitment is considered the definitive starting point for government permanent employment. The main function of the PSC is to conduct examinations for appointment in state services and prepare a merit-cum-seniority list of doctors based on the date of the PSC examination and the marks scored. Due to PSCs being overburdened, sporadic and often lengthy gaps of several years between PSC examinations are a pervasive problem (6, 15). Clearly this has ramifications over career trajectories for doctors because doctors who pass the PSC have their seniority listed from that date (irrespective of the work experience with the health department prior to the PSC examination). The rules and orders by the Government suggest for promotion by merit or on the basis of seniority, but seniority being the most important factor (16). If two doctors pass the examination at the same time, then the one who scores more in the PSC evaluation is placed higher on the seniority list.
The graph below has been constructed from the job histories of eleven doctors, eight from Sikkim (Doctor 4-11) and three from Rajasthan (Doc 1-3) giving graphic insight into comparison between doctors’ total service commitment and the portion (if any) recognised as permanent appointment.
As evident from the graph, the 11 job histories are quite varied. The time gap between recruitment to government services (either contractual, ad-hoc or temporary) to permanent recruitment through the PSC varies from as little as 2 months to as long as 60 months (doctors 1-6) . This missing bar for the two contractual doctors (doctor 10 and 11) suggests system inefficiencies. The PSC exam has not been offered in the past 10 years, and as result they have been continuing on temporary service for as long as 8-10 years. The missing bar for the three AYUSH doctors, however suggests that none have achieved permanent recruitment, despite 3-5 years’ service. Sikkim state accepts AYUSH doctors to meet temporary service demands, but does not recruit these doctors in permanent positions, effectively creating a ceiling to their potential careers, with no opportunity for permanent recruitment, irrespective of their years of service with government.
The graphic evidence highlights the variability in progression to permanent recruitment, attributable to the irregular availability of the PSC examinations, with its consequences for career trajectories of doctors, and the absence of an option to progress for AYUSH doctors in Sikkim state. Such career stagnation affects their motivation leading to high turnover rates.
“Our career progression is absolutely zero (laughs). Frankly speaking, you feel like you are stuck career wise. Other doctors have great avenues but for us there is no promotion. I have been working since 5 years and I know another AYUSH doctor who has been working since last 6-7 years … A regular doctor would hardly resign but for NHM doctors (referring to all contractual doctors recruited through NHM), especially AYUSH, job quitting happens every now and then. Since they have been working since 5-6 years, they get fed up, no job security, nothing, so everybody who’s working under NRHM, they are looking for something or the other like better opportunities or scope to study further... Again the new ones come and join the health department/NHM then leave… and the same cycle continues” (AYUSH 001)
Example 2: What is an appropriate location for an initial posting?
Job histories were analysed to determine the patterns of first posting for new recruits into rural services. As evident from the above figure, there appears to be no uniformity or consistency for the selection of first posting. It suggests that doctors may be posted to very rural PHC or to a rural PHC or to an urban District Hospital (DH) or even to the biggest hospital based at state headquarters. Recruits indicate hospitals are their first preference, rural PHCs their lowest preference. The job histories further suggest that the time spent at first post can significantly vary from 12 months to as long as 60 months and, depending upon whether a doctor considers the post as favourable or not, can have significant impact over their motivation.
The place of first posting and also time spent at first post is critical to doctors’ career progression. Interviews with KIs and doctors suggest that a HRM expectation that most initial postings are in rural PHCs; three years (36 months) of rural service entitle doctors to a posting at the state/district level. The job histories clearly suggest that the norms for first posting and duration are not consistently applied across the doctors. The study participants described a pattern of unpredictability in first appointments, but attributed irregularities to some doctors using political patronage to influence the place and duration of their postings to their benefit, while marginalising others.
Example 3: How long before a transfer and where?
(a) What kind of health centres are doctors posted to during their career?
(b) Whether such posting durations adhere to P&T policies or norms?
The job histories relating to transfer below aim to answer two critical questions: (a) What kind of health centres are doctors posted to during their career (b) Do such posting durations adhere to P&T policies or norms?
In terms of P&T, there appear to be no established patterns for movement of doctors either in relation to: (a) frequency of transfers (minimum or a maximum time they spend at a post) (b) place of health centre transfer (with movements from urban to rural or rural to urban or a mix of the two).
Individual job histories also allow normative comparisons against the generic P&T norms in civil service that suggests a recommended duration for each posting of at least 36 months (17) and preferably between 36-60 months (18). The minimum interval has been recommended in order to provide insulation to administrative officers and civil servants against political pressures from being too frequently transferred (17). As evident from the job histories, of the total 17 postings held across the four doctors, 12 (70%) did not comply with the transfer norm (the bold figures in the table above suggesting the deviance).
Example 4: How fluid or stable are transfers and do these comply with policies?
An alternative way of representing the job histories for another set of selected doctors is given below. As evident from the figure, frequencies of transfers and posts held vary significantly for the selected doctors and such variations can range from as low 2.5 months to 132 months suggesting a great fluidity or stability when it comes to occupying a post. These job histories also demonstrate that of the total 20 posts held by 4 doctors, 14 did not comply with the generic P&T rule of 36 to 60 months.