Decentralisation, health and Sustainable Development Goal 3.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2023-03-21 DOI:10.5588/pha.22.0034

R Anju, R Sadanandan, K Vijayakumar, V Raman Kutty, B Soman, R M Ravindran, R P Varma

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引用次数: 1

Abstract

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.

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权力下放、卫生和可持续发展目标3。

背景:25年前，印度喀拉拉邦通过转移行政控制和分配相当大份额的财政拨款，对医疗机构实施了下放改革。目的:描述喀拉拉邦权力下放对地方政策制定、项目实施和可持续卫生系统服务提供的主要影响。设计:这是关于喀拉拉邦权力下放与健康的更广泛定性研究的一部分。我们进行了25次深度访谈，审查了31份政府命令或政策文件、5份相关成绩单和5份主要研究的专题报告。结果:随着时间的推移，卫生系统与地方政府之间的联系有所改善。从以福利为中心的项目向基础设施、人力资源和服务的转变是显而易见的。由于社区的参与程度、能力、资源和需要各不相同，因此存在相当大的异质性。为实现联合国可持续发展目标(sdg)，国家层面的讨论和最近的加强努力强烈支持地方政府在规划、融资和实施方面的作用。结论:喀拉拉邦25年的分散医疗管理历史表明既有成功也有失败。在不剥夺地方政府权力的情况下，中央支持是一个可行的选择，可以使决策灵活，与更广泛的系统目标相一致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.