Decentralization of health services in India: barriers and facilitating factors
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Date
2012-02
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
Abstract
Background: In India, the process of decentralization of health services started taking shape
in the mid-1990s. Systemic reforms envisaged delegation of administrative and financial
responsibilities at district level for management of health-care institutions in 23 states of India
in 1999. Subsequently, some of these reforms became part of the National Rural Health Mission
(NRHM) launched in 2005. This study aims to document the process of decentralization in
health services with special reference to the barriers and facilitating factors encountered during
formulation and implementation of reform policies.
Methods: Secondary data were reviewed, health facilities were observed, and semi-structured
interviews of the key actors involved in decentralization were carried out in Haryana (India).
Results: Political and bureaucratic commitment to reforms was found to be the most important
facilitating factor. Orientation training on decentralized administrative structures and performancebased
resource distribution were the other important facilitators. Structural changes in
administrative procedures led to improvement in the financial management system. Significant
improvement in the public health infrastructure was observed. From 2004 to 2008, the state
government increased the budget of health sector by nearly 60%. Frequent changes in the top
administration at the state level hampered the decentralization process. Districts having a dynamic
administrative leadership implemented decentralization more effectively than the rest.
Conclusions: Decentralization of financial resources has improved the functioning of health
services to some extent. Major policy decisions on decentralization of human resource
management, increase in financial allocation, and greater involvement of community in decisionmaking
are required.
Description
Keywords
Health services, Policy, Programme, Qualitative, Decentralization, Management
Citation
WHO South-East Asia Journal of Public Health 2012;1(1):94-104