IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

Decentralisation of the health care sector in Kerala: Some issues

Listed author(s):
  • D. Narayana

    (Centre for Development Studies)

  • K.K. Hari Kurup

    (Centre for Development Studies)

Registered author(s):

    Kerala is in the forefront of decentralisation of powers following the 73rd and 74th Constitutional Amendments. The existence of a large number of health care, educational and other institutions in every Panchayat in Kerala has necessitated decentralisation of every sector as part of the overall decentralisation. The government order of 1995 has transferred the health care institutions at various levels to the local self government institutions (LSGI). This study seeks to analyse decentralisation of the health care sector in Kerala and the associated problems as perceived by the elected members. The study argues that three basic problems of decentralising the health care sector, namely spill over effect, role and relevance of a pre existing body (Hospital Development Committee or HDC), and the level of minimum health care service to be provided by the health care institutions, have not been adequately addressed. The problem of benefit spill over is quite serious with regard to the secondary health care services accessed from the Taluk Head Quarters Hospitals, which have been brought under the Municipal Councils. The problem arises from the concentration of hospital beds in municipal towns. The system of "matching transfers" might address the problem of benefit spill over but it will introduce a new problem owing to the inequality in the distribution of hospital beds across the taluks of the state. A separate fund on the lines of the "social investment" fund in Columbia might address this problem. Alternatively, private health care sector may be drawn in through a reimbursement scheme so as to ensure a minimum level of service. The presence of HDC in a decentralised system is difficult to sustain. Its continuance comes in the way of a proper functioning and accountability of the LSGI with regard to the provision of health care services. How exactly the functions of HDC should be integrated with the LSGI calls for further discussion.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL:
    Download Restriction: no

    Paper provided by Centre for Development Studies, Trivendrum, India in its series Centre for Development Studies, Trivendrum Working Papers with number 298.

    in new window

    Length: 35 pages
    Date of creation: Jan 2000
    Handle: RePEc:ind:cdswpp:298
    Contact details of provider: Postal:
    Peasanth Nagar, Trivandrum 695 011, Kerala

    Phone: +91 471 2448 881
    Fax: +91 471 2447 137
    Web page:

    More information through EDIRC

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    in new window

    1. Gerald Bloom & Tang Sheng‐Lan & Gu Xing‐Yuan, 1995. "Financing rural health services in China in the context of economic reform," Journal of International Development, John Wiley & Sons, Ltd., vol. 7(3), pages 423-441, May.
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:ind:cdswpp:298. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Shamprasad M. Pujar)

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.