The Forum of Federations – in partnership with the Observer Research Foundation – held the first of a series of comparative workshops on the decentralization of health care delivery, drawing on the experiences of Brazil, Canada, China, Colombia, Mexico and Spain. This workshop took place from February 9 to 10, 2004, in New Delhi. It was the first of a series of workshops planned in New Delhi, Ahmedabad and Bhopal, bringing together experts and officials from the relevant union government agencies, state agencies, international organizations (WHO, World Bank) and non-governmental organizations.
The process of economic globalization and the pressure to decentralize social policy sectors provide serious challenges to the sustainability of centralized delivery of public services, and the centralized health care system faces significant challenges. States often lack the fiscal ability to maintain, let alone expand the coverage of health care funded solely from public resources. This is further compounded by the complexity of intergovernmental relations. Given the absolute size of the population in India and its socio-economic heterogeneity, centralized efforts at health care delivery will need to be complemented by a system that is administered by local governments and/or community based organizations.
The goal of the workshops is to familiarize Indian practitioners with international experiences of decentralized health care delivery. The workshops are designed to inform the existing debate in India on how to manage the decentralization of health care delivery in the context of inter-governmental relations, ongoing economic reforms and globalization by drawing on the experiences of other countries grappling with issues of resource constraints and rising healthcare demands. The workshops seek to provide both the Union and state governments with a menu of options and inform them of potential pitfalls they seek to reorganize existing arrangements.