Health System Performance and the Extent of Engagement of the Local Self Government Institutions - A Qualitative Study from Rajasthan, India

Identifying factors that contribute the most towards meeting the healthcare needs of the population is of particular importance in a developing country such as India. Good governance in health should lead to provision of healthcare of acceptable quality that is physically and socially accessible to all segments of the population. It should moreover be delivered in culturally acceptable forms, without injuring basic human dignity or otherwise offending local customs. Allocation of scarce economic resouces between different groups and for different purposes is often the negotiated outcome of a complicated political process. Quality of public health is ultimately contingent on the quality of governance in a country. Recent changes in allocation of resources for health bring this fact to plain light. This study is an attempt to compile the grassroots perspective on health systems performance and the role of local self governements in improving the same. The study was performed in different regions on Rajasthan using mixed methodology approach. The methods included multi-state holder discussions, focus group discussion and surveys. This study highlights the multiplicity of factors that could raise barriers to healthcare access. These range from such obvious ones as lack of infrastructure or large distances, to such elements as information barriers, cultural outlooks etc that tend to be overlooked in many cases. The study findings reiterates the inter-connectedness of the numerous medical and non-medical determinants. Managing the multiplicity of factors and their numerous interactions will have to be streamlined by an appropriate program that combines the local context with the national scene. Key Words: Health systems, Role of local governments, Decentralisation, NRHM