Managing Public Health out of Own Source Revenue:: A Sample Study of Gram Panchayats in rural West Bengal, India

Panchayats for years have been the milestone for decentralization initiatives in West Bengal, India and also the state's penchant towards grassroots democracy. For a state experiencing financial crunch, devolution of financial and fiscal autonomy to the local governments had been the envisaged drive no doubt. For the overburdened state health system, sharing of responsibility by the Panchayats through public health expenditures made out of local revenue collected could have been a way out. Results also show that wherever the Panchayats have acted, the overall health situation (and also quality of life) has improved. But although they have much to do, and quite a scope, are they ready to make a paradigm shift from physical assets to quality of life? Their own fiscal health in general, their motivation to generate revenue on their own, and their capacity to act according to the local situation (without directives from upper tiers), and also their priority towards tangible assets that would at the end of the day earn them the vote-bank seem to speak otherwise. The analysis should help to comprehend the pitfalls and perils of development through decentralization.