Decentralized health planning: lessons from two districts in India.

Abstract

Drawing experiences from two case studies at two districts in India, this paper highlights several lessons for effective implementation of a district health planning policy. District plans for both groups are discussed. Though these district plans both aimed to improve maternal health care, they were different in various aspects: in their content, in the roles played by the state, how they utilized data, and the attention given to their implementation. Most items in the District A plan did not directly relate to the concern chosen for planning; decentralized planning allowed functionaries at each level to decide their own plans; used data to assess the performance on "Health for All" goals of the district, but not to identify reasons for low performance; and gave minimal attention to the implementation. On the other hand, the District B plan was more focused in its attempt to improve service delivery. The state took an active role in developing a district planning policy and used modular approach to planning and utilized data to determine factors associated with access and quality of services. District officers were directly involved in removing all implementation obstacles, gave large attention on solving implementation problems while encouraging nongovernmental organizations to play a supportive role. The contrasting experiences of these two plans indicate that the success of decentralized planning relies on the degree of administrative and implementation support provided by the state, nongovernmental organizations, the community, and stakeholders. Conclusions and policy recommendations were given.