Local Self Governance In Public Health Sector

Abstract

One of the principal goals of any health care system is to improve health through the provision of clinical and public health services.Decentralisation (orlocal self-governance) as a reform measure newlineaims to improve inputs, management processes and health outcomes, and has political, newlineadministrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of decision space at the local level. Studies have used different approaches to examine one or more facets of decentralisation and its effect on health system functioning; however, lack of consensus on an newlineacceptable framework is a critical gap in determining the quantum and quality of local decision making in public health sector. newlineLocal decision making is linked to several service quality improvement parameters. Rogi Kalyan Samitis (RKS) as composite bodies at peripheral decision making health units (DMHU) are mandated to ensure accountability and transparency in governance, improve quality of services, and facilitate local responsiveness. Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of newlinethe most critical building blocks. In India, (RKS) was established in all health unit as institutions of local decision making in order to improve productive efficiency and quality. However, measuring efficiency of health units is a complex task. Quality is a multi-faceted and all pervasive concept. There is lack of consensus on how best to measure it in different contexts. newlinePerceived quality of care by the end-users is often used to measure quality of health care services in public and private health care delivery system. Theorists have resorted to concepts of trust , convenience and mutual benefits to explain,define and measure components of governance in health. In the emerging continuum of health services model, the challenge lies in identifying....