Assessing the performance of primary health centres under decentralized government in Kerala, India

Abstract

Decentralization brought no significant change to the health sector. Active panchayat support to PHCs existed in only a few places, but wherever it was present, the result was positive. Kerala should find an alternative strategy to channel panchayats towards health before health loses its battle for resources.

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

“…More recently, several Latin American countries have invested heavily in primary care expansion with impressive results. Furthermore, several of the reforms in Latin America were implemented with a rigorous evaluation component, (Magnani et al, 1996) Niger X X (Pence et al, 2007) Ghana XXX (Hill et al, 2000) Gambia XX (Pannarunothai et al, 2000) Thailand X X X (Vapattanawong et al, 2007) Thailand XX (Wysocki et al, 1990) Southeast Asia X (Withanachchi et al, 2006) Sri Lanka X X (Fernando, 2000) Sri Lanka X X (Jayasinghe, 2004) Sri Lanka X X X X (Nair, 2004) Kerala, India X X X (Nag, 1988) Kerala, India X X (Varatharajan et al, 2004) Kerala, India X X (Aghajanian et al providing strong evidence of their effectiveness ( (Mullan & Frehywot, 2007). The integration of improved child health and chronic disease services as well as HIV diagnosis and treatment with primary care at the community level has been demonstrated to be successful in even the most resource-constrained countries and has resulted in improving geographic availability of life-saving services to rural populations.…”

“…Adequate and equitable funding is crucial to protecting families from hardship related to the costs of seeking primary health services. This is demonstrated in former ''model'' primary care systems such as those of Kerala and Sri Lanka where underfunding of primary care delivery in rural areas is raising out-of-pocket spending for the poor who are forced to use private providers or travel further to get quality health care (Varatharajan, Thankappan, & Jayapalan, 2004;Withanachchi & Uchida, 2006). An important mechanism by which primary care can reduce the financial burden on families is to reduce over-treatment, particularly the excessive use of medications and multiple providers.…”

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

“…These were corroborated from other studies in India [50][51][52][53][54][55][56]. In order to link with the needs of the broader community, each peer support group was encouraged to identify prevention activities that might engage other individuals in their community.…”

Emerging opportunities for recruiting and retaining a rural health workforce through decentralized health financing systems

“…6 Similarly, in the Indian state of Kerala, effective financial intervention from local government authorities is shown to have improved staff performance. 1 Moreover, successful implementation of payment systems linked to performance for the public health workforce has been noted in Brazil, China, Costa Rica, Romania and Rwanda. 2 …”

“…The main advantage is the dynamism it can bring into the resource allocation mechanism; it also can facilitate re-allocation of funds through a visible, vibrant and bottom-up approach. 1 Besides bringing in additional financial and human resources, it can also improve utilization of existing health-care resources such as staff.…”