Higher autonomy of panchayats leads to better health outcomes in rural India: Data

Panchayats which have a better say over power, people, and money also feature high on health, nutrition and sanitation scores

Updated - February 08, 2024 07:03 pm IST

Published - February 08, 2024 05:00 pm IST

Health care in panchayats: Rural Healthcare Worker administers vaccine for a woman as part of their door to door vaccination program.

Health care in panchayats: Rural Healthcare Worker administers vaccine for a woman as part of their door to door vaccination program. | Photo Credit: VIJAY SONEJI

The Data Point published on February 5, had highlighted how panchayats earn only 1% of their income through taxes, with the rest being sourced from Central and State grants. The Reserve Bank of India (RBI) study, based on which the report was written, had called for greater autonomy for panchayats and empowerment of local leaders. This Data Point aims to show that greater autonomy of panchayats results in better governance and leads to superior outcomes.

Panchayats collaborate with health departments to maintain clinics and dispensaries in rural areas. By encouraging institutional deliveries and ensuring prenatal and postnatal check ups, they help reduce maternal and infant mortality rates (IMR). They also provide clean water and sanitation facilities. All these help improve health outcomes. The RBI study uses two datasets to show that panchayats which scored high on the health, nutrition, and sanitation parameters also had lower rural IMRs.

Chart 1 | The chart shows the State-wise average of panchayat-level health, nutrition, and sanitation scores calculated by the Ministry of Panchayati Raj (MoPR) on the vertical axis.

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The scores of all the panchayats in a State were averaged to present the State’s overall score on these parameters. On the horizontal axis, the IMR of the State is presented. Both data were for 2018-19. In general, as shown by the trend line, the higher the score on health, nutrition, and sanitation parameters, the lower the IMR.

Major States including Kerala, Tamil Nadu, Himachal Pradesh, Punjab, Jammu and Kashmir (before it became a Union Territory), Karnataka, Maharashtra, and West Bengal all feature on the top left. That is, they have a high score and a low IMR. Madhya Pradesh, Uttar Pradesh, Assam, Rajasthan, Odisha, and Chhattisgarh can be seen on the bottom right — they have a low score and a high IMR.

Also read: There is hardly any autonomy at the panchayat level

Given that panchayats play a vital role in health management and as Chart 1 shows that some States outperform others, Chart 2 checks whether these better-performing States also have greater autonomy at the panchayat level. For this, the RBI study uses the devolution index prepared by MoPR using independent agencies. The devolution index rates a State based on three parameters.

First, the transfer of subjects, that is, how many functions including drinking water, rural housing, family welfare, and women and child development are under the control of panchayats. Second, transfer of functionaries, that is, how many positions were filled by panchayats on their own. Third, transfer of finances, that is, what share of funds are raised by panchayats on their own and what share can they spend based on their decisions. These three and some other categories are used to calculate the devolution index.

Chart 2 | The chart plots the States’ devolution index calculated by the Ministry of Panchayati Raj (MoPR).

The States on the right — Kerala, Karnataka, Maharashtra, and Tamil Nadu — have higher devolution scores. The States on the left — Assam, Odisha, Chhattisgarh, Madhya Pradesh and Uttarakhand — have lower devolution scores. Chart 1 and 2 when read together shows that panchayat autonomy plays a vital role in better health outcomes in rural areas.

Map 3 | The map shows the percentage shortfall of primary health facilities in rural areas, across States.

Grey denotes States where health facilities were in surplus in rural areas

Map 3 also concurs with this conclusion as States which perform better on the index have a surplus, with a few exceptions. Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh and West Bengal have very high levels of shortage. On the other hand, Kerala, Tamil Nadu, Karnataka and Himachal have none.

Source: RBI report titled, ‘Finances of Panchayati Raj Institutions’

Listen to our Data podcast: Vital Signs Ep 2 | Is medical education tailored to fill the shortage of specialists in rural India?

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