Decentralization, Reforms and Health Services Organizations: Conflicts, Contradictions and Diversities in Indian States
As a parallel process, decentralization has in recent years become a tool. The new conceptualization underemphasizes the political and democratic content of the process and promotes privatization as the complete form of decentralization. The poor have to counter the techno-managerial forms of decentralization in the era of Structural Adjustment. Many people are reconciled to the fact that there are no options available to the poor against the onslaught of neo-liberal agenda. However, there are some interventions in the available spaces to bring back people’s power to the centre stage as against the techno-managerial visions. The decentralization initiative undertaken in India is such an effort.
In this backdrop, we did a qualitative study in three states of India to explore the pattern of decentralization with regard to health services. We studied the responses of the elected representatives, the new breed of planners and executives at the lower levels of governance. We found that health services occupied the least priority among the elected representatives at the lower levels of governance. Bureaucrats consider elected representatives and people as incompetent to handle issues related to development and health. This results in conflicts at the lower levels. Even in this conventional form of political decentralization, there have been confusions about the extent of power, resources and responsibilities to be transferred to the lower levels as bureaucrats and politicians normally do not like their power to be curtailed. We argue that these confusions work as channels to usher in the neo-liberal packages in decentralization.
Keywords: Decentralization, Health Services in India
Prof. K. R. Nayar
Professor, Centre of Social Medicine and Community Health
He is directing two projects; one on Monitoring Shifts in Health Sector Policies in South Asia funded by the European Commission and another on E-Learning in public health funded by the German Academic Exchange and Bielefeld University, Germany. Professor Nayar co-organizes the annual International summer school on public health at Bielefeld University, Germany with Prof. Oliver Razum and Prof. Seval Akgun.