PRIVATE SECTOR SOLUTIONS TO PUBLIC SECTOR PROBLEMS? GOVERNANCE DESIGN CHALLENGES OF NEW PERFORMANCE REGIMES IN INDIA'S PUBLIC HEALTHCARE SYSTEM

Abstract

This thesis explores the performance challenges of New Public Management (NPM) reforms in India’s public healthcare system, offers design explanations for its failures and proposes governance design solutions. It argues there exists a disconnect between public service motivation (PSM) and governance design scholarships which limits solution-driven analyses of NPM reforms, and that for reforms to be effective, their designs must incorporate an understanding of motivational drivers of behavior and institutional features that condition performance. By combining causal theorizing and mechanism design thinking with the rigor of statistical public administration research, this thesis offers an analytical framework to unite PSM-oriented scholarship with governance design discourse and collocate motivational and institutional variables that affect the behavioral outcomes of public sector workers into a causal model of performance governance. In doing so, it tackles the knowledge problem and underscores the complementarity between these often-disjointed paradigms and their combined relevance for effective governance design.