<sec> <title>INTRODUCTION:</title> In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based (‘Aardram’) initiative. It was envisioned that the mission’s implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care. </sec> <sec> <title>METHODS:</title> The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema. </sec> <sec> <title>RESULTS:</title> The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of ‘Aardram’ primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed. </sec> <sec> <title>CONCLUSION:</title> Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study. </sec>

<sec> <title>SETTING:</title> Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation. </sec> <sec> <title>OBJECTIVE:</title> To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems. </sec> <sec> <title>DESIGN:</title> This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study. </sec> <sec> <title>RESULTS:</title> Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation. </sec> <sec> <title>CONCLUSION:</title> The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals. </sec>

Context: Arogyakiranam program, a state-run health entitlement scheme, caters to health care needs of 0 to 18-year-old children, in government hospitals of Kerala. Very few studies have been conducted in this regard. Aim: An interim analysis of the functioning of this program through stakeholder perspective facilitates understanding the mode in which the program is currently progressing, thereby paving way for bettering it further. Methods and Material: A qualitative study in three purposively selected districts of Kerala consisting of in-depth interviews was conducted across different levels of stakeholders including officials from different health care levels and beneficiary caretakers who bring their wards to these centers. Results: The functioning of the scheme with regard to implementation, fund flow, monitoring, documenting, reporting etc., was found to be following a fine structure. The scheme provides financial risk protection to the beneficiaries’ families. Perceived challenges were lesser public awareness of the scheme, the requirement of an updated guideline, funds, the need for the availability of specialists and other amenities. Complete electronic hospital proceedings, a separate account for the scheme, staff reorientation/training, more reviews, and appraisals were emphasized. The overall functioning of the scheme is found to be streamlined and highly fruitful in terms of catering to the child population in the state. Conclusion: Arogyakiranam program has proven to be a boon to its beneficiaries with nil out-of-pocket expenditure, providing an array of health care amenities, ensuring equity thereby relentlessly working towards universal health coverage.

<sec> <title>SETTING:</title> In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP). </sec> <sec> <title>OBJECTIVE:</title> To examine the role of local governments in the implementation of NACP in tune with SDGs. </sec> <sec> <title>DESIGN:</title> We conducted a state-wide exploratory study using document reviews, key informant and in-depth interviews, which were analysed thematically. </sec> <sec> <title>RESULTS:</title> Four overarching themes that emerged were 1) preparation for programme implementation, 2) positive impact of local government involvement, 3) convergence with other organisations, and 4) barriers to implementation. Local government commitment to implementing the programme was evidenced by their adoption of the HIV/AIDS policy, facilitative interdepartmental coordination and local innovations. Interventions focused on improving awareness about the disease and treatment, and social, financial and rehabilitative support, which were extended even during the COVID-19 pandemic. Fund shortages and poor visibility of the beneficiaries due to preference for anonymity were challenges to achieving the expected outcomes. </sec> <sec> <title>CONCLUSION:</title> The NACP is ably supported by local governments in its designated domains of interventions, prevention, treatment, and care and support. The programme can achieve its target to end the AIDS epidemic by overcoming the stigma factor, which still prevents potential beneficiaries from accessing care. </sec>