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Enhancing Services of Panchayat Raj in Public Health

* Ramaiah Bheenaveni

Panchayats in India are an age old institution for governance at village level. In 1992, through the enactment of the 73rd Constitutional Amendment, Panchayati Raj Institutions (PRI) were strengthened as local government organizations with clear areas of jurisdiction, adequate power, authority and funds commensurate with responsibilities.

Panchayats have been assigned 29 rural development activities, including several, which are related to health and population stabilization. The XI schedule includes Family Welfare, Health and Sanitation, (including hospitals, primary health centers, and dispensaries,) and the XII schedule includes Public Health.
“Thus the possible realm of influence of the Panchayats extends over a significant proportion of public health issues. The Gram Sabha, where empowered has the potential to act as a community level accountability mechanism to ensure that the functions of the village Panchayat in the area of public health and family welfare, actually respond to people’s needs”.

The 73rd Constitutional Amendment makes it mandatory that functions related to the provision of primary health care – maternal health and family welfare are the responsibility of the PRIs. Besides the various development sector departments come under the functional jurisdiction of the district panchayat. Creating a health system with the panchayats being made responsible for supervising and monitoring health services seems an ideal model.

The National Health Policy, 2001, also emphasizes implementation of public health programmes through local self-government institutions, especially relating to the national disease control programmes. The Planning Commission set up a Task Force to review PRI involvement in various sectors and to make recommendations on engagement of PRIs specific to each sector. A Task Force Report pertaining to five major programmes within HFW and the particular functions of PRI. The Task Force Report summarizes key functions for each of the tiers of the PRI in respect of five major programmes- Reproductive and Child Health (RCH), and programmes for Vector Borne Diseases, Blindness TB Control Programmes, and STI/AIDS. Many of the activities proposed are related to identification of people in need of services, in collaboration with the health system and monitoring of village level health workers, and Primary and secondary health care facilities. Currently the PRI are not equipped to take on such planning and monitoring functions, nor is there a cognizance in the health system of the role of PRI.

Critical Role of Panchayati Raj Institutions in the success of the National Rural Health Mission

PRIs are seen as critical to the planning, implementation, and monitoring of the NRHM. The NRHM is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. Key to the success of the NRHM are: intersectoral convergence, community ownership steered through village level health committees at the level of the Gram Panchayat, and a strong public sector health system with support from the private sector. Underlying this is a commitment to systemic reform within the health sector for better regulation of medical establishments, public health oriented medical education, strengthened management capacity, and effective and rational human resource policies. Success of the NRHM in achieving its outcomes is significantly dependent on well functioning gram, block and district level Panchayats. It is anticipated that in the NRHM, a Task Force will be set up to specifically recommend and study the centrality of PRIs to the NRHM.