Source: The Hindu Relevance: GS Paper ll (Indian Polity-Governance/ Panchayat Raj)

Context: The recent publication by the Reserve Bank of India emphasises the importance of granting financial independence to Panchayat Raj Institutions, underscoring their significance.

Key Findings:

➢ The RBI study highlighted that merely 1% of the income of panchayats is generated through taxes, while the majority comes from grants provided by the Central and State governments.

➢ According to the report, Panchayats exhibiting greater levels of functional and financial independence demonstrate superior performance in areas such as health, nutrition, and sanitation.

➢ Regions with higher scores in health, nutrition, and sanitation parameters exhibit lower Infant Mortality Rates (IMR), as evidenced by the example of Kerala.

➢ The RBI employs the devolution index, developed by the Ministry of Panchayati Raj (MoPR), to examine whether states with superior performance also grant greater autonomy to panchayats.

  • For instance, Tamil Nadu displays a high devolution score alongside a low IMR.

➢ When analysing it becomes evident that panchayats endowed with higher levels of devolved power tend to achieve better health outcomes in rural regions.

Devolution Index Criteria:

➢ Subject Transfer: The devolution index evaluates states based on the transfer of subjects, including areas such as drinking water, rural housing, family welfare, and women and child development, which are placed under the jurisdiction of Panchayats.

➢ Functionaries Transfer: Another aspect assessed by the devolution index is the transfer of functionaries, which involves determining the number of positions filled by Panchayats independently, reflecting their autonomy in personnel management.

Finance Transfer: The devolution index also considers the transfer of finances, assessing the ability of Panchayats to raise their own funds and exercise autonomy in decision-making processes related to financial matters.

State-wise Analysis:

➢ Regions such as Kerala, Tamil Nadu, and Himachal Pradesh, boasting elevated scores in health parameters, record reduced rural infant mortality rates (IMR).

➢ In contrast, states like Madhya Pradesh, Uttar Pradesh, and Assam, characterised by lower health ratings, demonstrate elevated IMRs.

➢ States with heightened devolution index scores, indicative of enhanced panchayat autonomy, tend to exhibit superior health outcomes.

Kerala, Karnataka, Maharashtra, and Tamil Nadu demonstrate heightened devolution scores, aligning with improved health metrics.

➢ Conversely, states such as Assam, Odisha, and Chhattisgarh display diminished devolution scores, correlating with inferior health outcomes.

Panchayat Raj Institution:

➢ Panchayati Raj Institution (PRI) refers to a framework of rural local self-government established in India.

➢ Local Self Government involves the administration of local affairs by elected local bodies representing the local populace.

➢ The constitutionalization of PRI occurred through the 73rd Constitutional Amendment Act of 1992, aiming to foster democracy at the grassroots level and entrusting rural development responsibilities to these institutions.

➢ In its current configuration, PRI has been in existence for 26 years. However, there remains significant work to be done to advance decentralisation further and bolster democracy at the grassroots level.

Addressing India’s Health Challenges Through Panchayat Autonomy:

Universal Health Coverage: Panchayats, when empowered, can play a pivotal role in extending healthcare coverage to marginalised and underserved populations.

  • By leveraging their local knowledge and resources, Panchayats can implement targeted health interventions to reach every doorstep, thereby advancing the goal of universal health coverage.

Maternal and Child Health: The high maternal and child mortality rates in India underscore the urgent need for focused interventions at the grassroots level.

  • Empowered Panchayats can strengthen maternal and child health services, promote institutional deliveries, and enhance access to antenatal and postnatal care, reducing preventable deaths thereby and improving health outcomes.

Non-Communicable Diseases (NCDs): India is witnessing a rising burden of non- communicable diseases such as diabetes, hypertension, and cardiovascular ailments.

  • Panchayats, with autonomy, can implement preventive health measures, conduct screenings, and establish community-based NCD clinics to mitigate the impact of these diseases, thus promoting healthier lifestyles and reducing healthcare costs.

Case Studies and Exemplary Initiatives:

➢ The success of Rajasthan’s ‘Mukhyamantri Nirogi Rajasthan’program, which empowers Panchayats to lead health and sanitation initiatives, showcases the transformative potential of decentralised health governance.

Tamil Nadu’s robust decentralised healthcare system, characterised by empowered Panchayats, has yielded commendable health outcomes, including high immunisation coverage and improved maternal health indicators.

Challenges and the Way Forward:

Capacity Building: Investing in capacity-building initiatives for Panchayat representatives and health workers is crucial to enhance their skills and knowledge in health governance.

➢ Inter-sectoral Collaboration: Fostering collaboration between Panchayats, healthcare institutions, and other stakeholders is essential to address the social determinants of health comprehensively.

➢ Policy Reforms: Enacting supportive policies and legal frameworks that empower Panchayats with greater autonomy in health governance is imperative to unleash their full potential in driving positive health outcomes.

In conclusion, the analysis underscores the critical link between devolution of power to Panchayati Raj Institutions (PRIs) and improved health outcomes at the grassroots level. States with higher levels of autonomy for PRIs tend to exhibit better health indicators, emphasising the importance of decentralisation in strengthening rural governance and fostering public health.

Advait IAS