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Decentralisation, health and Sustainable Development Goal 3
R Anju1, R Sadanandan2, K Vijayakumar1
1Health Action by People, Thiruvananthapuram, India.
Public Health Action
|March 23, 2023
Summary
Kerala
Area of Science:
- Public Health
- Health Systems Management
- Decentralisation
Background:
- Kerala, India, initiated healthcare decentralisation 25 years ago, transferring administrative and financial control to local institutions.
- This reform aimed to improve local policy formulation, programme implementation, and service delivery for sustainable health systems.
Purpose of the Study:
- To evaluate the primary impacts of healthcare decentralisation in Kerala.
- To assess the effectiveness of local governance in planning, financing, and implementing health services.
Main Methods:
- A qualitative study involving 25 in-depth interviews.
- Review of 31 government orders/policy documents, related transcripts, and thematic reports.
Main Results:
- Improved liaison between the health system and local governments.
- A notable shift from welfare projects to infrastructure, human resources, and service-focused initiatives.
- Significant variation in outcomes due to differences in community capacity, resources, and needs.
Conclusions:
- Kerala's 25-year experience with decentralised healthcare shows mixed successes and failures.
- Continued central support, balanced with local autonomy, is crucial for flexible decision-making aligned with system goals.
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