Decentralization and Interventions in the Health Sector

Abstract

The democratic decentralization process was launched in Kerala with the Peoples Planning Campaign in 1996 followed by the 73^rd and 74^th Amendments to the Constitution of India and the passing of the Kerala Panchayat Raj Nagara Palika Act. One of the major objectives of the decentralization process in Kerala was to strengthen the public health care network and improve the quality of public health service delivery. This article attempts to analyze the transition in the health care sector during the last two decades linking it to the interventions of Local Self Governments (LSGs). It was found that decentralization improved infrastructure facilities and equipment in primary and secondary health care institutions and widened health care delivery. It succeeded in providing safe drinking water and sanitation facilities to the local people. The accountability of the public health care system was also enhanced. However, it could not address the issues of nutritional imbalance, old age care, lifestyle diseases and the changing morbidity pattern in the state. This article calls for a comprehensive health policy to ensure functional autonomy for LSGs to address the emerging health care needs in Kerala.