Effectiveness of Local Government and Community Participation in Health Service Delivery in Rural Haryana

Abstract

The recent health sector reform initiatives argue that health service delivery mechanism can be made effective through the participation of local governments and community in policy making, planning and services delivery. We believe that the gain from such initiatives to the large extent depends on how these initiatives are implemented at the ground level. In order to evaluate their effectiveness, this study first captures the degree of local agent’s participation and extent of decentralization in health, and then measures their impact on health service access and health-seeking behaviour of rural households, controlling for socio-economic, demographic and political factors, such as reservation of women/minority groups in politics. This exercise is largely based on field survey data collected from 12 villages of Haryana. The results show that the degree of community participation and women/minority groups’ reservation in politics hardly matters for promoting the equity in access to health care. This may be because dominant class/caste/male captures most of the decentralization powers in Haryana. A properly designed and implemented decentralized policy however turns effective in promoting the health care use from public facilities. The study argues that the gains from decentralization can be enhanced by devolving more health-related functions, funds, management, regulation and policy making powers to local Panchayat and community. The magnitude of Panchayat support and priorities to health and coordination between local agents and health functionaries is a value addition for materializing the greater gains from such decentralized initiatives.