Utilisation of Fifteenth Finance Commission’s Health Grants: A Kerala Story

Abstract

This paper evaluates the strengths, weaknesses, opportunities, and challenges involved in the management and utilisation of health grants in Kerala, a state renowned for its decentralised healthcare system, with the support of empirical evidence from all the urban and rural local governments in the state. It critically explores the factors that led to poor utilisation of health grants through the lens of politicisation, personalisation, corruption, post-office syndrome, capability traps, poor self-esteem, over emphasis on legalistic framework and rule-bound approaches, and relative absence of thick and thin accountability. While the 15th Union Finance Commission took inspiration from the Kerala model of decentralised healthcare to involve the rural and urban local governments in the health sector and extend additional resources to strengthen the primary health system at the grassroots level with the introduction of health grants, the shocking underutilisation of health grants in the model state is a disappointing one.