Re-engineering primary healthcare in Kerala.

Area of Science:

• Public Health
• Health Governance
• Primary Health Care Reform

Background:

• Kerala's 'Aardram' initiative revamped Primary Health Centres (PHCs) into Family Health Centres (FHCs) for comprehensive primary care.
• The initiative aimed to integrate decentralized governance for improved healthcare delivery.
• This study examines the influence of decentralized governance on primary care reorganisation.

Purpose of the Study:

• To explore the impact of decentralized governance on the reorganisation of primary care in Kerala.
• To understand how local governments engaged in health system planning and implementation.
• To identify facilitators and challenges in implementing primary care reforms through decentralized structures.

Main Methods:

• Qualitative exploratory approach utilizing key informant interviews (n=8) and in-depth interviews (n=20).
• Document reviews were conducted to supplement interview data.
• Thematic analysis with deductive coding was employed to identify emergent themes.

Main Results:

• Strong political commitment and bureaucratic competence facilitated the 'Aardram' initiative.
• Multi-sectoral training enabled local governments (LGs) to engage effectively with the health system.
• Decentralized governance supported PHC re-engineering through resource mobilisation, infrastructure development, and community participation.
• Challenges included non-uniform commitment, suboptimal urban LG engagement, and sustainability concerns.

Conclusions:

• Decentralized governance positively influenced PHC re-engineering, promoting participatory health governance.
• Empowering local governments through capacity building is crucial for achieving primary care Sustainable Development Goals (SDGs).
• The study highlights the potential of decentralized models for effective primary healthcare delivery.