| Autor: |
Anju, R., Sadanandan, R., Vijayakumar, K., Raman Kutty, V., Soman, B., Ravindran, R. M., Varma, R. P. |
| Rok vydání: |
2023 |
| Předmět: |
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| Zdroj: |
Public Health Action |
| ISSN: |
2220-8372 |
| DOI: |
10.5588/pha.22.0034 |
| Popis: |
SETTING: Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation. OBJECTIVE: To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems. DESIGN: This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study. RESULTS: Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation. CONCLUSION: The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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