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Decentralisation of governance and maternal healthcare utilisation: Evidence from India

Author

Listed:
  • Bharti Nandwani

    (Indira Gandhi Institute of Development Research)

  • Ishita Verma

    (Indira Gandhi Institute of Development Research)

Abstract

This paper examines the impact of a decentralisation program implemented in India's Schedule Five Areas - home to 100 million indigenous people (Scheduled Tribes, or STs) - on maternal healthcare utilisation. The program institutionalised local governance councils and introduced political reservations for STs, granting these councils formal authority over the provision of public goods and services. Using three rounds of a large-scale reproductive health data and a difference-in-differences strategy exploiting staggered program implementation, we find that the policy significantly increased the use of antenatal care services, particularly from government facilities. It also reduced delivery complications and increased reliance on public services for managing such complications. Evidence suggests that these improvements were driven by increased trust in the health system when political representatives belonged to the ST community. The findings highlight how decentralisation combined with political inclusion can improve public service utilisation and health outcomes among historically marginalised population.

Suggested Citation

  • Bharti Nandwani & Ishita Verma, 2025. "Decentralisation of governance and maternal healthcare utilisation: Evidence from India," Indira Gandhi Institute of Development Research, Mumbai Working Papers 2025-014, Indira Gandhi Institute of Development Research, Mumbai, India.
    • Handle: RePEc:ind:igiwpp:2025-014
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    File URL: http://www.igidr.ac.in/pdf/publication/WP-2025-014.pdf
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    References listed on IDEAS

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    Keywords

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    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • P16 - Political Economy and Comparative Economic Systems - - Capitalist Economies - - - Capitalist Institutions; Welfare State

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