WHO South-East Asia Journal of Public Health
  • 317
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
POLICY AND PRACTICE
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 94-104

Decentralization of health services in India: barriers and facilitating factors


1 School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
2 Department of Health, Panchkula, Haryana, India

Correspondence Address:
Manmeet Kaur
School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh
India
Login to access the Email id


DOI: 10.4103/2224-3151.206920

PMID: 28612783

Rights and Permissions

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 performance-based 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 decision-making are required.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed756    
    Printed10    
    Emailed0    
    PDF Downloaded130    
    Comments [Add]    
    Cited by others 5    

Recommend this journal