Urban governance and health care provision in Delhi

Abstract

This paper considers how changes in urban governance in Delhi over the last two decades have influenced the provision of health care services. It begins by describing the introduction of, or return to, elected governments for the National Capital Territory of Delhi and for the Municipal Corporation of Delhi. It then discusses public health care, which in effect serves low-income groups as most higher-income groups now use private services, and how this has changed, drawing on interviews and direct observations of elected representatives and officials at state and municipal levels, political cadres, NGOs, members of residential welfare associations and public health care users. The research focused on four municipal wards that included a middle-class area, a mixed-income area, a ward where many slum communities had been relocated and an "urban village". The research also included an analysis of the priority given to health care issues (and what those issues are) in the Legislative Assembly and in the Municipal Health Department and Municipal Health Committee. The paper suggests that the opening by state government of new invited spaces for resident welfare associations meant that the elected members of the Legislative Assembly and of the municipal government were by-passed. It increased the influence of resident welfare associations, but these are a feature of middle-class areas whose inhabitants use private health care. It avoided contestation, as the state could decide who was invited. The role of NGOs as advocates for the urban poor also diminished, as many were drawn into becoming implementers of government programmes. In effect, this increase in participation can be seen as a new form of centralization, strengthening the position of senior bureaucrats and by-passing the elected politicians.KEYWORDS decentralization / Delhi / health care / neighbourhood associations / NGOs / participation / urban governance I. INTRODUCTIONThis paper considers the provision of public health care services as a case study of the changes brought about in urban governance in India in the past 20 years, with a focus on Delhi. Since the early 1990s, economic liberalization, politico-administrative decentralization and the large consensus around the desirability of "good governance" as defined by the World Bank(1) have doubtlessly transformed urban governance. Recent studies suggest that one of the characteristic features of the contemporary management of urban affairs is the multiplication of actors involved in it.(2) This evolution is particularly striking in Delhi, whose Chief Minister since 1998, Sheila Dixit, has paid special attention to governance issues. It is difficult, however, to distinguish a pattern behind the series of reforms, policies and schemes that have been announced and implemented in quick Stéphanie Tawa LamaRewal is a Research Fellow

Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries

“…In India, Resident Welfare Associations in New Delhi participate in Municipal HCs, but tend to take up issues relevant to the upper and middle classes (such as mosquito control) rather than demanding improvements in public healthcare provision because "only the servants go there" (Lama-Rewal, 2011).…”

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“…From 1992, Health services in India were delegated to the administrative districts of each of the 23 state governments (Kaur et al, 2012). Lama-Rewal, 2011). In urban India the health system is highly diverse, ranging from private health care services to public health care to traditional healers.…”

“…This was further strengthened by the WHO) report which explicitly recognized governance as a key pillar of health system building blocks framework. The significance of a decentralized governance of health systems is to improve decision making at local levels in different tiers of health service delivery and to ensure a constantly growing involvement at several levels of government as well as the private sector (Lama-Rewal, 2011). It is in this respect that the World Development report appreciated partnerships in the form of investment in the health sector by both bilateral and multilateral donors like UNICEF, USAID, World Bank support of projects (World Bank, 1993).…”

“…The current discourse supporting decentralization, primarily carried by the World Bank and adopted, with local variations, in a majority of countries in the past two decades, argues that one of its main impacts is to make the administration more responsive to people's needs (Lama-Rewal, 2011). Public Private Partnerships (PPPs) do not occur uniformly, it can take a form or a combination that exists in a continuum ranging from Public Enterprises at the weakest and private venture at the other end (Obosi, 2015).…”

Political Representation in the Discourse and Practices of the “Party of the Common Man” in India

“…He's given a letter to the concerned Minister and asked "please advise your officials to cooperate with them." (Interview, Delhi, 2016) This semi-institutionalization of MLA representatives, this emphasis on a transparent deconcentration of the MLA's mediation work, precisely demonstrates a will to differentiate MLA representatives from the multiplicity of mediators that characterises Delhi's governance (Tawa Lama-Rewal, 2011) such as party workers, "informal leaders", or the self-appointed representatives of Resident Welfare Associations.…”