Health Care for Rural Poor: Decentralization of Health Services in Karnataka,India

T. V. Sekher, Institute for Social and Economic Change

Decentralization of health sector results in greater community participation that leads to improved service quality and coverage. It also helps in focusing attention on vulnerable social groups, emphasizing preventive measures and reorienting programs to meet specific local needs. In this context, the paper examines the process and impact of decentralization of health services in India following the 73rd Constitutional Amendment. It looks into the devolution of powers and resources to local self-government institutions and also the coordination mechanism existing between the department of health and local bodies for planning and implementing health programs. The paper is based on a field study in 2001 covering three tiers of rural decentralized bodies at the District, Block (intermediary) and Village levels in Karnataka. The findings indicate an overall improvement in the quality of service delivery, accountability of personnel, and utilization of health services, despite financial constraints and lack of administrative clarity.