Urban Health Sector in South Kerala: Exploring the Role of Local Government Institutions

Abstract

Background: Following rapid urbanization in Kerala, the urban population grew faster with different health needs, widening the socioeconomic and health inequity. The urban primary health centers were formed, and with the introduction of decentralized governance, the primary and secondary health-care facilities in the urban region were transferred to the urban local bodies (ULBs) such as corporations and municipalities. This study tried to explore the role of the local government institutions in the urban health sector of Kerala. Methodology: Qualitative approaching was used involving in-depth interviews and secondary data analysis of health financing data from ULBs. The settings were purposively chosen from different levels of ULBs in South Kerala. Results: The in-depth interviews were analyzed deductively based on the themes evolved from the larger project. The major finding of the study was organized under the themes: (1) fund allocation and resource mobilization, (2) drinking water and waste management, (3) challenges in project implementation, (4) health care of vulnerable populations under the ULBs, and (5) Kudumbashree and community participation. Conclusion: The findings from thematic analysis and secondary data analysis lead to the conclusion that most of the ULBs focused on health-related domains such as sanitation, drinking water, waste management, and nutrition. The financial and administrative support given to health facilities was limited due to many factors including lack of resource availability, low autonomy, and low community participation. Despite this, many ULBs made efforts to collaborate with health facilities and other stakeholders to implement innovative and need-based health projects.