Bottoms Up: To the role of Panchayati Raj Institutions in Health and Health services

Accountability
(2010)

India is currently witness to two trends that have the potential to significantly improve the health of its people. The first is the growing recognition that the system of public delivery of health services is in crisis. And the second is India’s bold efforts to strengthen the voice of the rural poor through decentralization to local governments.This paper argues that these two ostensibly separate trends can converge to generate real reform in the health sector in India through the potential for increased accountability that local governments can provide. The argument is that decentralization brings governments closer to people thereby allowing them to respond more effectively to local needs and preferences. Thus efforts at rural decentralization (post the 73rd amendment) have been undertaken within the context of strengthening accountability in governance structures. Moreover, proximity encourages better monitoring and enforcement.

In the specific context of the health sector, a decentralized institutional structure that emphasizes a bottom up, participatory approach can indeed help to redress some of the key failings in the sector such as absenteeism and corruption by strengthening accountability. As Dr. Jaiprakash Narayan, member of the National Advisory Council has put it: “The struggle for better health, the fight for accountable democracy, the quest for peoples sovereignty and the urge for best value for public money spent are all inseparable.” Given GoIs renewed emphasis on decentralization, this paper aims to analyze the specific role that decentralization can play in strengthening accountability in the public delivery of health care and offers some  suggestions at how best this may be achieved.

Bottoms Up: To the role of Panchayati Raj Institutions in Health and Health services