Decentralization of Health in the Indian State of West Bengal : Analysis of Decision Space, Institutional Capacities and Accountability
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Washington, DC
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India has embarked on a substantial
program of decentralization following the 73rd and 74th
Amendment Acts to the Constitution, which call for
establishing and significantly empowering Panchayati Raj
Institutions (PRIs) at district, sub-district (block), and
village and urban local levels. The World Bank's India
program is interested in these developments and is
considering how it should support the Government of India
(GoI) objectives in these governance reforms. A wide range
of support mechanisms is possible, including lending and
analytical work, and focusing on national- or state-level
activities and direct support for local governments or
actions through specific sectors, such as the health sector.
The study focused on five functional areas of decisions
about health systems, strategic and operational planning,
budgeting, human resources, service organization or
delivery, and monitoring and evaluation. Prior studies in
other countries and Indian states had found that
decentralization of decisions, capacities and accountability
varied considerably among these functional areas. In West
Bengal, the formal decision space allowed for a significant
range of choice over planning, service organization,
monitoring and evaluation and less range over budgeting and
human resources. The survey questionnaire asked specific
questions about what choices the respondents had actually
made within the possible choices granted by the formal range
of choices.
Palabras clave
ADMINISTRATIVE RULES, AGRICULTURE, BASIC HEALTH CARE, BLINDNESS, CHILD DEVELOPMENT, CHILD HEALTH, CHILD NUTRITION, COMMUNITY PARTICIPATION, DECENTRALIZATION, DECISION MAKING, DELIVERY SYSTEM, DISEASE CONTROL, DISEASES, DOCTORS, EXERCISES, EXPENDITURES, FAMILY PLANNING, FINANCIAL MANAGEMENT, FINANCIAL PLANNING, HEALTH ADMINISTRATION, HEALTH CARE DELIVERY, HEALTH CARE FACILITIES, HEALTH CARE INFRASTRUCTURE, HEALTH CENTERS, HEALTH CENTRES, HEALTH FACILITIES, HEALTH INDICATORS, HEALTH INFORMATION, HEALTH NEEDS, HEALTH ORGANIZATION, HEALTH PLANNING, HEALTH PLANS, HEALTH POLICY, HEALTH PROGRAMS, HEALTH PROJECT, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH SPENDING, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEMS, HIV/AIDS, HOSPITALS, HR, HUMAN RESOURCES, HUMAN RESOURCES MANAGEMENT, IMMUNIZATION, INCOME, LAWS, LEPROSY, LITERACY LEVELS, MEDICAL CARE, MEDICAL FACILITIES, MEDICINES, MORTALITY, NURSES, NUTRITION, PRIMARY CARE, PRIMARY HEALTH CARE, PUBLIC HEALTH, PUBLIC HEALTH PROGRAMS, PUBLIC HEALTH WORKERS, PUBLIC SECTOR, RURAL DEVELOPMENT, RURAL HEALTH CARE, RURAL HOSPITALS, VILLAGE HEALTH WORKERS, WORKERS