Decentralization of health services: the Kerala People's Campaign.

The 1996-2001 Kerala People's Campaign for Decentralized Planning has provided much new information about the possibilities and potential of decentralizing public health and health care services. Analysis of investment patterns of the various government levels involved in the campaign, supplemented with case study materials, allows for an evaluation of the decentralization project against its own stated goals. These included (1) creating a functional division among government levels appropriate to the health tasks each level can best perform; (2) generating projects that reflect the felt needs of the people, as voiced through local participatory assemblies; (3) maintaining or increasing levels of equality in health, especially with regard to income, caste, and gender; (4) stimulating communities to mobilize voluntary resources to supplement devolved public funds; (5) stimulating communities to create innovative programs that could become models for others; and (6) making the health services function more effectively overall. The analysis supports the conclusion that the campaign achieved each of the goals to a large degree. Shortcomings arose from the inexperience of many local communities in drafting effective projects as well as problems deriving from the fact that some sections of the health bureaucracy could not be decentralized. Lessons of the campaign are already being applied to new programs in Kerala.