LSG & Public Health

Decentralized governance in Kerala has been unique as is evident from the conception and implementation of the entire process since its inception in 1994 and further developments since 1996. Decentralization of governance in Kerala was primarily a developmental approach focusing on a political movement and public action in the state for achieving economic development and social justice through democratic means. The political and administrative processes and reforms have markedly influenced all development sectors including Public Health. Kerala state had remarkable achievements in conventional health indices but has been facing new demographic, epidemiological, environmental and politico-economic challenges.The decentralized governance model implemented by the state holds promise in helping the state achieve scaling newer heights in development indicators. The framework put forward by decentralization enables participatory planning and implementation at the grass root level.In this book, we explore the changes brought by decentralized governance and its pathways focusing on health sector. In ‘health sector’ we include everything that relates to (i) the running of the health institutions transferred to the local bodies such as primary health centres (PHCs),community health centres (CHCs), Taluk headquarters hospitals (THQHs) and district hospitals (DHs) (ii) preventive and promotive, curative, rehabilitative and palliative services in the State (iii) closely allied sectors and projects – working of Anganwadis under the Integrated Child Development Services scheme (ICDS), the palliative care initiatives helmed by the panchayat, old age homes and other care homes and institutions for people with special needs by the Department of Social Justice, Women and Child Welfare etc.The impact of decentralization in the health sector of the state has been studied comprehensively by categorizing selected domains into several themes in this project. Some of the major themes include: (i) administrative processes as represented by relevant Acts, Rules,Guidelines and Orders pertaining to decentralization and health (ii) discourse on the history of decentralization from key stakeholders who actively involved in the process over the years (iii)implementation of national and state health programmes and initiatives, (iv) addressing vulnerable groups, and particular challenges like disaster and health emergencies.A state wide research was conducted cutting across sectors and governance levels. Attempts has been made to map out the dynamics between different actors like elected representatives,health workers, community members, policy makers and officials of various departments. By examining the various processes involved in decentralized governance on health across the state, a synthesis of the restructuring that happened, facilitating factors and challenges was evolved from the study. The findings throw light on effective implementation of decentralization for health and well-being of people that would inform further research,support evidence-based policy making in developmental initiatives and health system reforms based on decentralized governance in low-and-middle income countries