Political Decentralisation & the Primary Health Care System

At this meeting, findings were presented from a two-year research project examining the implications of health sector reforms for reproductive health services in India. The purpose of the project is to provide information on how to shape reforms that seek to effectively promote reproductive rights and health and gender equity. District-level research studies were conducted in Kerala which examine the implications of reforms for reproductive health services for health systems, users, and providers.

According to this report, the transfer of Primary Health Centres (PHCs) to the Panchayati Raj Institutions (PRIs) provides leverage to communities and women in shaping priorities in Kerala, India.

The objectives of this research project are:

1. To study the potential of the Reproductive and Child Health programme to improve women's access to quality reproductive health care services;
2. To examine the role of decentralisation through the People's Plan Campaign in improving local priority setting for women's reproductive health needs; and
3. To examine the dynamics of women's reproductive health care seeking in terms of socio-economic, culture and gender factors.

The report offers a range of women's perceptions about health care. For instance, women believe that contraceptives can adversely affect their health. From a cultural persepective, women prescribe to the gender role of taking responsibility for reproduction which leads them to accept contraceptive responsibility. The report notes that women believe that contraceptive use can cause reproductive morbidity.

The report shows that health care sought by women ranges from self-care using indigenous products to attending tertiary sector hospitals. And in some cases, the reason for a lack of cure stems from an inability to express problems to male doctors or from a lack of resources, for instance, not buying the complete dosage of medication prescribed. The report also points out that the women who can speak frankly with their partners and who can participate in PRI processes freely have the potential to improve their reproductive health.

According to the report, "political decentralization was examined as a process that has the potential to bring about substantial improvements in the health care delivery system as well as women's reproductive health care in Kerala." The reform of the health care system is seen as having three components in Kerala: the primary health care system; the Panchayats & People's Planning Campaign; and the community whose lives are most affected by the reforms.

The report concludes that "the process of decentralization in Kerala has the potential to influence women's development through their participation in grama sabhas and neighbourhood groups. Decentralization has created the opportunities for women to cross the thresholds of their homes and participate in potentially democratic processes not available earlier. The decentralization process has also created an opportunity for women's participation in democratic political processes at the Panchayat level by reserving one third of the elected seats in all the three tiers of local self-government for women."

Click here for the full report.For further information contact: change@genderhealth.org