Decentralized Participatory Planning and Peoples Plan Campaign in Kerala

1
Decentralized Participatory Planning and Peoples
Plan Campaign in Kerala

• D. Varatharajan
• Achutha Menon Centre for Health Science Studies
• 7th March 2003
• New Delhi

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Rationale for PRI control over PHCs

• PRIs have the potential to improve the perceived
  inefficiency of Government healthcare system
  under-utilisation of PHCs
• Marginalisation of poor due to lack of effective
  and affordable care
• Political mandate provided by 73rd Constitutional
  Amendment Act, 1992

3
Objectives

• To study the potential of the reproductive and
  Child Health programme to improve womens access
  to quality RH services
• To examine the role of decentralisation in
  improving local priority setting for womens RH
  needs
• To examine the dynamics of womens RH care
  seeking in terms of socio-economic, cultural
  gender factors

4
Specific Research Questions

• What are the systemic changes due to political
  decentralization that affect government
  healthcare services?
• What are the effects of these changes on resource
  allocation to health/RH?
• How effective are the linkages between Panchayats
  and PHCs after decentralization?

5
Methods

• Stakeholder interviews
• State - Interview guide, 17 Stakeholders
• Local Interview schedule, 29 Stakeholders
• Stakeholder workshop Triangulation,
  presentation on successful experiments,
  collective understanding of issues concerning PPC
• 35 participants
• Review of state budgets, Govt. orders,
• Gramasabha minutes Panchayat devt.
• reports (199702) from health perspective
• Study Period April October 2002

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Study Sites

• Selection of districts based on RH index
• Thiruvananthapuram and Palakkad (average dist)
• Choice of Panchayats based on resource allocation

High
PHC
Block PHC
Taluk Hospital
Medium
PHC
Low
PHC
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Themes of Analysis

• Description of the process of decentralisation
• Allocation of resources to health
• Relationship between PHCs and Panchayats

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Theme-1 Description of the Process of
Decentralization
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Policy Context

• 1993 73rd 74th Constitutional Amendments
• 1994 Kerala Panchayati Raj Act
• 1995 Legal transfer of managerial, fiscal
• political functions to Panchayats
• 1996 Launching of PPC
• 1999 Restructuring of Act
• 2000 Transfer of institutions completed
• 2002 Limiting untied grants to 33

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Panchayati Raj

• Involves entire community to identify their
  health problems as it has the greatest interest
  in improving the conditions that affect its
  people.
• Kerala devolved 35-40 of the 9th Plan outlay to
  programmes drawn up by Grama Sabhas through an
  initiative called Peoples Campaign for 9th Plan.

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Peoples Plan Campaign Phases

• Gramasabhas
• Identify the felt needs
• Development seminars reports
• Analyse developmental problems
• Task forces
• Assess the local resources
• Panchayat Plan
• Not confined to Plan resources alone
• District Plan
• State Plan

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Devolution Package

• State Resources

Non-Plan (67)
Plan (33)
WCP (10)
State (67)
Panchayats (33)
Service sector (30-40)
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Panchayats in Kerala

• Maximum autonomy in the planning process
• Promote both economic development social
  justice emphasis on planning
• 991 village panchayats
• Area 2 795.3 sq. km.
• Covers on an average a population of 25,199
• Every village Panchayat has a PHC, High School,
  veterinary Hospital etc.
• Own revenue was 44 of total receipts in 1993-94
  (India 10)

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Potential Benefits for PHC

• Development of Infrastructure
• Creation of new institutions not possible
• PHC maintenance (from 2001)
• 10 of Plan funds can be spent on this
• No contingency
• No medicines
• Local management

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Theme-2Allocation of Resources to Health
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Panchayats resource in 2001-2 Rs. 9.8 Mn
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• Panchayti raj provided opportunity for govt.
  health care units to have liquid reserve to
  spend on local priorities
• Plan allocation to health
• 3.0 in 1997-98
• 2.3 in 2000-01
• 2.7 by state govt.
• 1.8 by Panchayats
• Pachayats controlled 11 govt. resource but
  shared only 2.8 of govt. health exp.

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• Ayurveda received more resource than allopathic
• Panchayats didnt look beyond Plan resources
• RCH attracted lot of state or other resources but
  they were not streamlined

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Reasons for Low Allocation

• Lack of resources
• Lack of expertise training among PRI members to
  prioritise, seek assistance through projects
  utilize available resources in a cost-effective
  manner
• Low priority to health overall
• Panchayats simply do not have perspectives on
  womens health issues

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Conclusions

• There has been a decline in Plan resource
  availability to health after decentralisation
• However, Panchayats provided a flexible resource
  base to PHCs
• Resource allocation to Women Component Plan was
  4.5 in 2001 against mandatory 10
• Women Component Plan allocated less to health
  compared to General Plan

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• Thank You