Institute for Social and Economic Change

Working Paper: 271

Decentralisation and Interventions in
Health Sector: A Critical Inquiry into
the Experience of Local Self
Governments in Kerala


M Benson Thomas
K Rajesh



The Democratic decentralisation process was launched in Kerala with the Peoples Planning Campaign in 1996 followed by the 73rd and 74th Amendments to the Constitution of India and the passing of the Kerala Panchayat Raj Nagara Palika Act. One of the major objectives of the decentralisation process in Kerala was to strengthen the public healthcare network and improve the quality of public health service delivery. This paper attempts to analyse the transition in the healthcare sector during the last two decades linking it to the interventions of Local Self Governments (LSGs). It was found that decentralisation improved infrastructure facilities and equipment in primary and secondary healthcare institutions and widened healthcare delivery. It succeeded in providing safe drinking water and sanitation facilities to the local people. The accountability of the public healthcare system was also enhanced. However, it could not address the issues of nutritional imbalance, old age care, lifestyle diseases and the changing morbidity pattern in the state. This paper calls for a comprehensive health policy to ensure functional autonomy for LSGs to address the emerging healthcare needs in Kerala.

Working Papers