With the line of accountability between the State and the Centre regarding healthcare blurring time and again, is a judicious mix of federalism and decentralisation the key to addressing the sector’s woes? The highly decentralised healthcare model of Kerala holds the answer to its quick and prompt response to the COVID-19 pandemic. As such, COVID-19 presents an opportunity to re-evaluate the structure and efficiency of India’s healthcare system.
In India, healthcare is designated as a state subject; the states are solely responsible for providing health and allied services to its citizens. But this does not guarantee a comprehensive autonomy to the states, as they have to rely on the Centre for the most crucial element—financial support. The Centre’s interest in healthcare also goes beyond finances and encapsulates health infrastructure, management of institutions, regulatory onus, medical education, training, research and more importantly healthcare policies. Major healthcare programmes in the country such as National Cancer Control Programme, National Leprosy Eradication Programme, National Aids Control Programme, National Mental Health Programme and National Health Mission (NHM) are driven by the Centre and implemented by the states, making the lines of control a tad blurry. This causes obscurity in the accountability for the organisation of the healthcare system in India, one of the major challenges India’s healthcare system faces currently. The states also have their own mechanism to design policies and disburse their resources for meeting their own healthcare needs, but this means that the quality and accessibility to healthcare will deviate across states.
Views expressed are personal and need not reflect or represent the views of Centre for Public Policy Research