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1. Family planning occupied a subordinate position in the medical and health bureaucracy almost two decades after its introduction. Senior Ministry officials accorded low priority to formal program objectives, while the State Family Planning Officer, the highest state official concerned solely with the family planning program, suffered from a relatively subordinate position in the Directorate and a lack of authority and support. Within the medical profession, family planning was held in low esteem, and the medical and health bureaucracies did not have a mechanism for selecting personnel on the basis of interest and commitment. 2. Organizational adjustment to family planning in the Ministry of Health was a slow and painful process, absorbing the energy and attention of Ministry officials for almost a decade. The repeated reorganizations of the district setup revolving around the division of labor between medical, health, and family planning acitvities and between the rural and urban program, led to months of almost total inertia and detracted substantially from the supervisory capacity of the officials involved. 3. Decision making and guidance suffered from the quick turnover of the Secretary, the most powerful administrator in the Ministry. In Uttar Pradesh Secretaries stayed barely long enough to begin to understand the complex organizational setup of the program. 4. Multiple and often conflicting lines of authority characterized the relationships between the higher and lower echelons within the Ministry. This was accentuated when the District Family Planning Officer was placed under the administrative control of the District Magistrate. While intended to "energize" family planning through the association of the most prestigious and powerful district official with the program, this organizational arrangement resulted in conflicting instructions to the staffs of the primary health centers. 5. The organizational behavior of the Ministry of Health was shaped by the interplay of the various "professional cultures" of its key actors. The generalist administrators' short time horizon and eagerness to produce quantitative results clashed with the specialists' emphasis upon long-term goals and technical constraints; the politician's defense of the interest of his constituents clashed with the administrator's desire to defend his autonomy. The calculus of political survival made support for family planning goals a costly burden that few politicians have been willing to shoulder. As the party system does not reward the advocacy of family planning, ministers emphasize those programs within their ministry or those decisions within their discretion that correspond to the demands of their constituents.Organizational problems that were critical factors in the massive failures during the implementation of the family planning (FP) program in Uttar Pradesh, India, are identified: 1) FP held a subordinate position in the Ministry of Health. 2) Organizational adjustment to FP was slow and painful, with repeated and paralyzing reorganizations around the issue of division of labor among medical, health, and FP activities. 3) The turnover in secretaries of the ministry was so high that none stayed long enough to understand the program, much less direct it. 4) There were multiple and conflicting lines of authority between higher and lower echelons of the ministry. 5) The interplay between "professional cultures" within the bureaucracy (generalists vs. specialists, politicians vs. administrators, and medical physicians vs. health physicians) worked consistently against the functioning of the FP program. It is suggested that no substantial improvement in the operation of the Uttar Pradesh FP program can be expected within the existing institutional framework - a bureaucracy with a limited capacity to implement social change programs. |
