Defining difficult public health facilities

Introduction In its efforts to strengthen the rural public health system, the National Rural Health Mission had to address the challenge of getting skilled health care providers to work in rural and remote areas. Learning from states, which had some measure of success with incentives for doctors in such areas, the central government decided to launch a scheme to provide these incentives to states. States were asked to prepare a list of difficult, most difficult and inaccessible facilities based on stated criteria for defining ‘difficulty’. However, these criteria evolved by states were often subjective and could not be applied consistently across states. In this regard, The National Health Resource Centre (NHSRC) was entrusted with the task of proposing a standard criterion for defining and determining ‘difficulty’ which could be consistently and objectively applied across all states and to recommend a policy for incentivisation. The paper draws on the study undertaken by the NHSRC that documented the process of evolving the criteria, validation, the process of negotiation with the states and outcomes in terms of standards for defining the criterion of difficult health facilities.