Health care in rural India in the context of decentralization : perception, participation, access and burden

The present study employing the 2006 Rural and Demographic Survey data, describes people’s perceptions of the existence of the health problems, the performance of the decentralized institutions, namely the panchayats and people’s participation in the regime of decentralized governance. The multivariate analyses estimate health care access, work days lost owing to illness and the treatment cost as a proportion of household income. Findings indicate that while there is a significant percentage of population that perceives the existence of the problem of the availability and accessibility of quality health care, there has been some increase in the significance accorded to health issues in the public discourse held in decentralized settings such as panchayat and gram sabha meetings. There are significant regional differences with the states of the South relative to the other parts, showing a more active role of the panchayat. The contrast is particularly notable when compared to the North. However, greater action by the panchayats is also associated with greater level of dissatisfaction, pointing towards some form of the paradox of participation. The multivariate estimates portray a positive role of decentralized governance in predicting health care access, loss of work days owing to illness and cost of treatment as a proportion of household income