Publication:

District health governance to improve service delivery of tea garden hospitals in selected districts of Assam: drivers of change

Background Decentralized governance across different tiers of healthcare delivery has proven to yield positive outcomes globally. To strengthen governance and improve service delivery in PPP Tea Garden Hospitals (TGHs), District Task Force (DTF) committees were instituted across selected districts in Assam. This study examines how DTFs influenced health service delivery using the World Development Report 2017 framework, focusing on credible commitment, coordination, and cooperation.

Methods A qualitative study was conducted across four districts in Assam namely Dibrugarh, Sivasagar, Jorhat, and Golaghat. Data collection included observation of DTF meetings and 23 in-depth interviews with key stakeholders in tea gardens. Data were analyzed thematically and triangulated across sources.

Results DTFs enhanced credible commitment through active participation of district administration, improving accountability and transparency in TGH operations. Coordination among NHM block officials and TGH staff was facilitated through structured reporting tools. However, inconsistent participation from non-health sectors and tea garden management limited cooperative efforts.

Conclusion DTFs have emerged as a promising model for decentralized, multi-sectoral health governance in Assam’s tea garden areas. Formalizing DTF protocols, incentivizing stakeholder participation, and addressing inter-departmental gaps can further enhance their effectiveness and scalability.