Democratic Decentralisation and the Millennium Development Goals for Health

Abstract

In the context of the targets for primary health identified by the MDGs this article evaluates the link between decentralisation and positive outcomes for women and children. Using India as a case study, the article traces the changes in health attainments as a result of decentralisation reforms. The evidence presented, drawn from the experiences of two states, speaks to the relevance of such a link. Despite the heterogeneity of contexts and in implementation, in general democratic decentralisation has enhanced health outcomes for women in the selected village Panchayats. However, the article unearths significant differences in the impacts of decentralisation between the two states. The variations in outcomes between the two states are found to be linked to the architecture of decentralisation design as well as to ‘non-statutory’ provisions that can create a process of path-dependency towards achieving MDGs. The article also flags key methodological complexities inherent in the current MDG framework with respect to the actualization of the goals of equity and access to primary health.