PANCHAYATI RAJ AND HEALTH Proceedings of the Seminar

Item

Title: PANCHAYATI RAJ AND HEALTH
Proceedings of the Seminar
extracted text: F’AMCSHATA'M

A®D HEUIH

Proceedings of the Seminar

Editor
S watha Rao

Foundation for Research in Community Health
1994

PAACHAYATI raj AW health

July 1994
Typeset at: Scan Grafiks Co., Pune

Printed at

: Bhave Copiers, Pune

Foundaton for Research In Community Health
Bombay Office

84 - A. R. G. Thadani Marg,
Worli, Bombay - 400 018.
Maharashtra, INDIA

Pune Office

3-4 Trimiti -B Apartments
85, Anand Park,
Aundh, Pune - 411 007
Maharashtra^..INDIA-

€( - 11 0

)^^r-

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FOREWORD
Despite pursuing a policy of Western style industrialization following Independence 74 %
of our population continues to live in 650,000 villages in rural India and another 10% in the urban
slums. This mode of development, which has created pockets of urban and rural'affluence, has
bypassed the poor and polarized our society. It has created social tensions which now threaten
our entire polity. It has also brought in a culture of materialism so alien to our civilization and
its values.
There is a great deal of disenchanment with this process of development which is now
being further foisted on us by foreign powers as a result of our indebtedness to them; This
concern has created the need for an alternative model which would be in keeping with the social,
economic and cultural needs of our people.
Such a model, in the form of Panchayati Raj, has been a part of our national heritage.
Decentralized, small-scale, people-based and people-involved form of life and development,
using the rich and varied human and natural resources that abound in the vast land that is
ours, has been a part of our native structure. In such a structure, except for a few national
objectives like foreign policy and defence, other aspects concerning the people do not lend
themselves to a centralized, uniform type of government or planning.

Fortunately for India, the democratic form of our polity also lends itself to a return to
this form of governance and development. This is a result of the remarkable foresight which
gave our people universal franchise at Independence. The power of votes is a silent
revolution whose magnitude we still do not appreciate. The 72nd Amendment of the
Constitution is a direct result of the exercise of people's power as a result of their votes. This is
despite four decades of failure to provide them education and keeping them deprived of basic
needs and information about their rights as citizens of a democracy.
The conceding of Panchayati Raj under the duress of the vote can only be the first step in
the people regaining ability over their own destiny. The transfer of administrative, even of
financial power, means little unless accompanied by sufficient financial resources. This can be
done, initially, by increasing the present paltry allocation and later, by utilization of locally
generated resources in a more equitable manner.

While 29 areas of social and economic development have been allocated to Panchayati
Raj under the 72nd Amendment this cannot be achieved unless the people are informed about
the details of each of these programmes as well as about Panchayati Raj itself. The essence of
Panchayati Raj is involvement of all the people at every level and their say in all matters
concerning their own and country’s welfare. The present method of seeking co-operation of
the people to fulfil government plans and programmes through a top-down bureaucratic service
is the very anti-thesis of Panchayati Raj. The bureaucracy is to support and work under the
panchayats who would pay them for their services. Since intense personal interaction is the
essence of this system of Panchayati Raj and since this ceases; beyond the Block or Taluka
level, Panchayati Raj cannot, by any stretch of imagination, extend beyond the Panchayat Samiti
level, i.e. a two tier Gram Panchayat and Panchayat Samiti level. The Zilla Parishad at the District
level was only an invention of the British for maintaining law and order and collection of revenue
by their bureaucracy, while distancing themselves from the people they ruled. To impose a threetier system as the unit of Panchayati Raj would be the perpetuation of the process of
exploitation of the people under the guise of administrative convenience. This does not
i
i

exclude co-ordinating functions at various levels.
The regaining of appropriated power by the people will have to be supported by public
information, sharing of successful experiences and, above all, by continuous monitoring of
elected representatives with the possible insistence of the right to recall. In this, motivated
individuals, organizations of the people and NGOs will have to pay an important role.
Dr. N.H. Antia

July 1994

Director

ii

ACKNOWLEDGEMENTS
The FRCH gratefully acknowledges the financial support it received for the Seminar from the Indian
Council of Social Science Research (ICSSR), the Ford Foundation and the Indian Council of Medical
Research (ICMR)and thanks the Western Regional Centre of the ICSSR for allowing the use of jts
facilities for the Seminar.
The editor wishes to thank Dr. N.H. Antia for the enlightening discussions, Chrissie D'Costa
and Ravindra Thipse for their painstaking contribution to organising the seminar, Nagmani Rao for
editorial help and Sunita Vichare for secretarial assistance.

iii

LIST OF PARTICIPANTS
Dr. Abraham NalinI
DANIDA
11, Aurangzeb Road,
NEW DELHI 110 011.

Gadgil Madhav*
Centre for Ecological Sciences
Ind. Inst, of Science
BANGALORE 560 012.

Dr. Antia N.H.
FRCH,
84-A, R.G.Thadani Marg,
Worli Sea Face Corner,
BOMBAY 400 018.

Mr. Kavadi Shirish
FRCH, 3/4, Trimiti - B Apartments,
85, Anand Park, Aundh,
PUNE 411 007.

Dr. Arora Rashmi
Assistant Director
Div. of Epidemiology, ICMR,
P.B.No.4508, Ansari Nagar,
NEW DELHI 110 029.
Dr. Awasthl Ramesh
FRCH, 3/4, Trimiti-B, Apartments,
85, Anand Park, Aundh,
PUNE 411 007.
Dr. Banerjee Shipra
Rural Medicare Society
Ward No.6, Peelkhana, Mehrauli,
NEW DELHI 110 030.

*
•

Prof. Banerjl Debabar
Nucleus for Health Policies & Progs.
B-43, Panchsheel Enclave,
NEW DELHI 110 017.

Dr. Bhargava B.S.
Inst, for Soc. & Eco. Change
P.O. Nagarbhavl,
BANGALORE 566 072.
Ms. Bhat Ela*
SEWA Reception Centre,
Opp. Victoria Gardens,
AHMEDABAD 380 001.

■
.

Mr. Chauhan Devra]
Economist
71, Gold Mist, Gulmohar Road,
J.V.D.P., Circle, Juhu Scheme,
BOMBAY 400 049.

Dr. Desai A.R.
Sociologist
Jai Kutir, Taikalwadi Road,
Mahim P.O.,
BOMBAY 400 016.

Prof. Desarda H.M.
Member
State Planning Board,
60, Mahajan Colony, CIDCO No.2,
AURANGABAD 431 210.

Mr. Krishnaraj
Economic and Political Weekly
Hitkari House
2874, Shahid Bhagat Singh Road,
BOMBAY 400 038.

Dr. Mandlekar V.B.
Retd. IAS
Flat No.5, Juhu Society,
Relief Road, Daulat Nagar,
Santacruz (W),
BOMBAY 400 054.
Prof. Mutatkar R.K.
Dept, of Anthropology
Pune University,
PUNE 411 007.

Dr. Prabhu Seeta
Dept. Of Economics
University of Bombay,
Vidyanagari Marg, Kalina,
BOMBAY 400 098.
Ms. Prakash Padma
Economic and Political Weekly
Hitkari House
2874, Shahid Bhagat Singh Road,
BOMBAY 400 038.

Dr. Raghuram Shobha
HIVOS Regional Office India
Flat 402, Eden Park,
Vittal Mallya Road,
BANGALORE.
Mr. Rao Sheshagirl
Centre for Ecological Sconce,
Indian Institute of Science
BANGALORE 560 012.

Dr. Rao Sujatha
FRCH
84-A, R.G. Thadani Marg,
Worli Sea Face Corner
BOMBAY 400 018.

Mr. Kulkarni Mangesh
11-C, Saraswati Baug,
Jogeshwari (E),
BOMBAY 400 060.

Mr. Duggal Ravi
SWISSAID India
Bldg.4, Flat 408,
Vahatuk Nagar, Amboli,
Andheri (W),
BOMBAY 400 058.

Dr. Shetty S.L.
EPW Research Foundaton
C-212 Akurli Industrial Estate,
Kandivli (E),
BOMBAY 400 101.

Prof. Dutta Gouri Pada
MLA, West Bengal,
43, Sarat Bose Road,
4th Floor,
CALCUTTA 700 020.

Dr. Sharma T.P.
Health & Family Welfare
Project
H-31, Nishat Colony,
BHOPAL 462 003.

Dr. George Jose
Dept, of Political Sc.,
University of Bombay,
Vidyanagari Marg,
Santacruz (E),
BOMBAY 400 001.

Ms. Shashikala K.
Institute of Social
Studies Trust,
57, Gayatri Devi Park Extension,
16th Cross Road, Vyallkaval
BANGALORE 400 012.

Mr. Godrej N.P.
Godrej Bhavan,
Homi Modi Street,
Fort,
Bombay 400 001.

Mr. Shroff K.C.
Excel Industries Limited
184/87, S.V.Road, Jogeshwari,
BOMBAY 400 102.

Dr. Gulati I.S.
Centre for Development
Studies,
Prasantnagar Road,
Ulloor,
TRIVANDRUM 695 011.

Mr. Suratwala S.R.
Sir Dorabji Tata Trust
Bombay House,
Homi Modi Street,
BOMBAY 400 001.

Mr. Hazare Anna*
Ralegan Siddhi
Tai. Parner,
Dist. Ahmednagar,
MAHARASHTRA.

Mr. Tendulkar Vijay*
206, Badridham,
S. Janaki Road,
Vile Parle (E),
BOMBAY 400 057.

Dr. Jesani Amar
310, Prabhu Darshan
31 S, Sainik Nagar, Amboli,
Andheri (W),
BOMBAY 400 058.

Mr. Unakar D.J.
Excel Industries Limited,
184/87, S.V.Road,
Jogeshwari (W),
BOMBAY 400 102

Mr. Kothari Rajni*
G 1/10, Lajpatnagar Part 1,
NEW DELHI 110 024.

Dr. Uplekar M.W.
FRCH,
84-A, R.G. Thadanl Marg,
Worli Sea Face Corner,
BOMBAY 400 018.

Dr. Krishnaswamy K.S.
Banashankari 2nd Stage
1706,14th Main, 30th Cross Road,
BANGALORE 560 070.

* These persons were unable to attend the seminar due to unavoidable clrcumstancs

v

PANCHAYATI RAJ AND HEALTH

Proceedings of the Seminar

A two day seminar on 'Panchayati Raj and Health’ was organised by the FRCH in Bombay
on 9-10 April, 1994. The seminar was called against the backdrop of the recently released book
People's Health in People's Hands : A Model for Health in Panchayati Raj by N.H. Antia
and Kavita Bhatia and the notion that is gaining increasing ground that the structural
framework for the delivery of health care must undergo a meaningful reorientation if the
Eighth Five Year Plan objective of health for the under privileged is to be achieved. Central
to the book was the advocacy of the idea that the Panchayati Raj (PR) system can be used as
an effective instrument for eliciting community participation in the health programme and for
providing supervision, which is essential for health care.
The participants in the seminar represented diverse disciplines and included doctors,
sociologists, social workers, economists, political scientists and civil servants.
In his opening remarks Antia noted that politicians have conceded and not willingly
given power to the people in the form of PR as a result of universal adult franchise. Since the
present centralised system has failed to deliver the goods, the people have to demand change
instead of succumbing to the TINA (There Is No Alternative) effect.

Briefly tracing the history of PR in Kerala, I.S. Gulati noted that, while it is true that
Kerala has surged ahead of the rest of the country in terms of life expectancy, reduction in
mortality rates and achievement on the family planning front, it is doubtful whether these
achievements can be attributed to local self-government. According to him, elections to the
PR institutions in Kerala have depended on the whims of the state administration. The District
Administration Act of 1979 somewhat strengthened the power of the PR institutions and so
expectations were high when PR elections ensued. Between 1980-88 no PR elections were held
in Kerala. However, when the UDF came to power in 1991,30 out of the 44 functions originally
listed for District Councils were immediately withdrawn from their purview. Thus, the
District Councils were forced to function without power.

The recent PR Bill of Kerala gives the state government draconian power over the PR
institutions. For example, the Bill provides for the appointment of a Commissioner at the state
level and Deputy Commissioner at the district level to control and take action against erring
PRIs. The PR members can be dismissed or disqualified by the Commissioners and the
Panchayats themselves can be dissolved if the Commissioner finds them to be in default. The
Bill also makes a distinction between mandatory functions of the PR institutions and
functions which would be transferred to these bodies subject to the availability of resources.
Public urinals and latrines are the only health-related areas listed among the 31 mandatory
functions for Panchayats, while more important functions, including management of government
dispensaries and maternal and child welfare centres, are to be under government control.
Thus, an opportunity to pass power to the village panchayats in managing their own health
was bypassed.
1

A brief review of the Kerala situation indicates that the road to effective ^centra
is far from smooth, given the unwillingness of the political leaders an ur®.^
further their
leave aside share power". In this context, Gulati noted howNGOs, in a i
,
own interests, have often acted in collusion with the bureaucracy an
le po i
circumvented the local bodies instead of strengthening them.
K.S. Krishnaswamy said that the experience of Karnataka largely substantiates what
Gulati said of Kerala, but is even more worrisome. This is because, while
as no reay
had a start in Kerala, in the case of Karnataka, having once been brought into existence, PR
institutions are in the process of being destroyed.
Karnataka has a long history of PR beginning with the Mysore Village Panchayatand
Local Boards Act. However, the autonomous structure of PR institutions envisaged in the
1950s failed to shape up. Thus PR institutions in Karnataka were not self-governing bodies,
but controlled by the state bureaucracy. The village panchayats were superseded on grounds
of maladministration and by 1980 there was no effective PR in Karnataka. The Janata
government's Karnataka Nyaya Parishad Act of 1983 (which received Presidential assent in.
1985) paved the way for elections in 1987. While this Act made clear reservation for women
and other weaker sections in the PRIs and led to the appointment of a Finance Commission
under the chairmanship of Havanur, in actuality, only developmental functions specifically
identified by the state government were transferred to the PRIs. The departmental officials
who carried out the functions inPanchayat related areas were servants of the state government
and were not accountable to the PR institutions.
The years that followed saw the fall of the Janata government and return of the Congress
party to power. The new Congress government introduced a number of amendments aimed
at curtailing the power of the PR institutions and withdrew several of the functions earmarked
for the PRIs and assigned them to state functionaries. The operation of the PRIs was restricted
to specific tasks where centrally sponsored schemes had to be implemented at the village level.
Simultaneously, through a series of ingenious moves, the Karnataka government managed to
halt the panchayat elections despite judicial orders to the contrary. The plea that the law and
order situation was not conducive to the holding of elections has also been used to stall the
PR elections. Though Karnataka had passed the model legislation in 1983 a subsequent
legislation in 1993 drastically decreased the power conferred on the panchayats under the
earlier Act.

A quick look at the working of the PR system in Karnataka indicates that the increasing
power of the bureaucracy and the nexus between them, the contractors and the politicians
have acted as a strong hindrance to the working of the PR system. The dichotomy of control
between the local government and the state functionaries is another feature working against
genuine transfer of power to the PR institution. As a result, the role of the local selfgovernment is likely to remain advisory, rather than operative in the real sense Though the
Havanur Commission Report was submitted in 1989, no action has been taken on its
recommendations. A disturbing new trend is the demand by the MLAs for access to
discretionary funds on the lines of the funds allotted to the MPs. If such a demand is granted
it is likely to increase the power of the politicians over the PR institutions.
6
The Karnataka Act provided for a State Development Council in order to enable the PR
institutions to sort out problems with the government. Except during the first year, when the
2

ouncil met twice, the state government has not evinced any interest in looking into the
problems of PR institutions through further meetings. Thus, it is evident that legislation alone
would not be sufficient to make the PR institutions effective instruments of transferring power
to the people.

Mandlekar, in his paper entitled 'Panchayati Raj in Maharashtra', provided a historical
background of the PR system. He noted that sporadic efforts at decentralised development
were made in various parts of the country even before Independence. The Rural Reconstruction
Programme, started by Maharajah Sayajirao Gaikwad in 1890 in Baroda, the Rural Reconstruction
Centres, started by Tagore in 1908 in Bengal, and the Self-help Multi -Purpose Development
Programme, started by Spencer Hatch of YMCA in 1921 at Travancore are examples.
Similar attempts continued after Independence, as exemplified by theNilokheri experiment
in Punjab, for rehabilitating the displaced persons from Pakistan, the Sarvodaya Plan, and the
Grow More Food Campaign culminating in the Community Development Programme in 1952.
The initial success of the Community Development Programme prompted the government to
rapidly expand the programme through the National Extension Service (NES) Blocks. However,
as years progressed, there was a sharp decline in people's participation in the programme. In
January 1957, the Government of India appointed the Balvantray Mehta Committee to study
the community projects and the NES with special reference to the problems connected with the
organic linking of village panchayats with popular organisations at higher levels. The Report
of this Committee was to later form the basis of PR in India.

As soon as Maharashtra state came into existence in 1960, a Committee on Democratic
Decentralisation was appointed under the chairmanship of Vasantrao Naik. The major
recommendations of the Naik Committee were incorporated in the Maharashtra Zilla
Parishad and Panchayat Samiti Act, 1961. Zilla Parishads (ZPs) and Panchayat Samitis came
into existence in Maharashtra in May 1962. On the basis of the experience gained and
recommendations made by the Bongirwar Committee of 1971 and P.B. Patil Committee of
1986, changes have been effected in the PR systems in the state without altering the basic
features that have been in existence for over three decades.
According to Mandlekar, some of the important achievements of PR in Maharashtra
include identification, promotion, training and growth of leadership from among the rural
masses, especially from the backward classes; an overall change in the outlook of the people
in accepting improved agricultural practices, family planning and vaccination of children;
spread of primary and secondary education, especially among girls and backward classes;
reduction in untouchability; vocalisation of rural masses, etc. Contact with the people and
their representatives directly in the course of their work has provided an excellent opportunity
to young administrators and technocrats to appreciate the working of the development
programme at the grassroots level.
Mandlekar listed the shortcomings of the system to include intrusion of political
parties, increased groupism on the basis of parochial considerations, and failure of the PR
institutions to increase their own resources, resulting in increased dependence on the
government, while giving the latter tremendous power to circumvent the very objective of
democratic decentralisation.

About 94% of a ZP's total annual income in Maharashtra consists of ’grants' from the
state government. The other 6% is its 'own' income and includes government-assigned
3

revenues such as cesses. Such a system of grants has been designed to sei ve the government s
interest and has almost crippled the ZPs, financially. About 65% of a ZP s income, w let ler
own or through grants, is earmarked for primary education; and 98% of this is uti ise or
teachers' salaries. Thus, there is very little money available for or spent on equipping sc ools
or improving the quality of teaching.
The deterioration in the working of the PR is attributable to several factors. The
establishment of the District Planning and Development Council and the District Rural
Development Authority increased the power of the already powerful District Collector, by
extending his authority to areas falling under the jurisdiction of the ZP. Members of the State
Legislature dominate these parallel power centres. Other ills include postponement of
elections on some pretext or the other; appointment of administrators for ZPs, theieby
virtually converting them into an appendage of the state government; and retaining in the
state sector important schemes with huge financial outlays (essentially meant for the uplif tment
of the socially and economically backward classes) instead of transferring them to PR
institutions.

Suggestions for remedial measures included holding of timely elections and ensuring of
representation to all sections. It was felt that no separate agency or office should be
established by the state government for the administration of schemes transferred to PR
institutions, so that autonomy of the PR institutions can be ensured in keeping with the spirit
of the 73rd Amendment. While MLAs of the concerned district may be associated with the
working of the ZPs, they should not be eligible to hold office in the PRIs. The District Planning
and Development Council will have to be reconstituted giving representation to ZPs, Panchayat
Samitis and Village Panchayats, as well as urban local self-government institutions. Finance
Commissions, which would have to go through a whole gamut of issues — including
estimation of the PR institutions' capacity to raise resources and requirements of grants-in-aid
and other transfers — should be appointed regularly, every five years.

An important development in recent years is the narrowing of the rural-urban divide due
to the growth of industries in rural areas, commercialisation of agriculture, rural-urban
migration, expansion of communication, commercial banking, etc. This calls for increased
coordination between urban and rural local self-government institutions in areas of common
interest. In fact, instead of keeping the two separate, we may have to think in terms of
establishing a single district local self-government body.
According to Desarda, the PR system has not been given a fair trial in Maharashtra, but
it has the potential for decentralising the power structure.

The experience of West Bengal vindicates the fact that the PR system would succeed if it
gets the right backing. Gouri Pada Dutta drew attention to the success of the PR institutions
in West Bengal, where the Left party has held elections to Panchayats on party basis every five
years and the system has survived four elections. On the other hand, in Tripura the defeat of
the Left party led to a dismantling of PR.
1
The West Bengal PR Act was passed in 1957 and was implemented in phases The Left
Front government, elected in 1977, implemented the Ashok Mehta Committee Report.

In other states like Karnataka, Andhra Pradesh and Kerala, the experiment of political
panchayats did not survive the changed governments at the state level. West Bengal is the only
4

state where all the political parties openly participated in the elections. Prof. Dutta noted how
the PR system successfully tackled the devastating flood of 1978 by organising relief work
efficiently.
West Bengal has reserved 38% of the seats for women and 33% for scheduled
castes
and tribes. The Panchayat department has undertaken an extensive training programme for
all elected members of panchayats to educate them on the objective and functioning of PR
system as also on health and education.

Panchayats have also participated in the centrally sponsored anti-poverty programme by
selecting beneficiaries with utmost care. Under Jawahar Rojgar Yojna (JRY), the West Bengal
panchayats have succeeded in targeting the beneficiaries with remarkable accuracy and
reaching benefits to them. The targets have been surpassed every year, from 1985 to 1992.
The number of people below the poverty line has decreased by 15% in West Bengal visa-vis an all-India reduction of 11%. Agriculture in West Bengal has registered a sustained
growth, with the state recording the highest production in the country in rice and second
highest in potato, in recent years.

PR has also brought about material and socio-psychological changes. The feudal land
relationships have been replaced by a new social order. There is a qualitative change in the
life of the rural people as a result of the traditional Left political movement of the state which
has given stability to the panchayats in a process of dynamic equilibrium between the two.

Despite a fair degree of success, panchayats in West Bengal face various problems, both
conceptual and operative. The conceptual problem is a basic one concerning the autonomy
of the PR institutions. Autonomy does not mean independence. In the context of the
Panchayats' relation with the state government, the extent of power that has to be vested with
the panchayats should be debated and the respective roles of the people, the political parties
and the administration have to be defined accordingly. The operational problems are myriad.
Economic programmes and those relating to social justice are formulated by experts and
executives at the central and state levels and panchayat members are directed to implement
them. Thus panchayats are accorded neither a role in formulating plans nor freedom to fix or
change priorities, and are reduced to being mere implementation agencies. Often, panchayats
are engaged in routine work and implementation of the JRY schemes seems to have become
their main preoccupation. In this context, it is heartening that an amendment of 1994 proposes
to empower the Gram Sansads to evolve local plans in West Bengal.

The PR leaders who implement programmes are looked upon by the people as a new set
of bureaucrats and this brings about a gulf between the people and the elected members.

People often tend to demand everything from the panchayats but do not contribute their
mite to optimise the panchayat activities. As a result, the very idea of self-government gets
defeated and people's dependence on external help increases instead of decreasing.
In West Bengal, though a large share of developmental assistance is distributed through
the ZP, a mechanical approach akin to giving doles to the poor characterises the disbursement.
Such a mechanical approach leads to corruption, both among the recipients and the givers,
often resulting in lack of accountability and poor recovery. Panchayats are not vested with

5

power over government employees and have, therefore, to depend to a great extent on the
goodwill of the administrators. Besides, in recent years the control of the rural scenario has
shifted from the traditional landlords to the middle class rural elite, mainly consisting of
school teachers. This new power group has blocked the downward movement of power to
people.
The PR institutions in West Bengal are surviving by the political will of the Left Front.
People have to be alert that panchayats do not lose their identity as an institution. Here, it is
important to develop local leadership and create a strong presence by taking up schemes for
literacy, health, voluntary social labour and the like.

Speaking on the social implications of PR, A.R. Desai drew attention to the broader
perspective in which the working of the PR system has to be viewed, by pointing out how
larger forces have affected the village community. According to him, villages are not
undifferentiated harmonious entities, but reflect the iniquituous social relationships based on
caste and class. Into this system, the British rule introduced a new pattern by injecting the
principle of primacy of individuals rather than groups. During the British period, land came
to be considered a commodity and the collection of revenue in terms of cash pushed money
to a position of prominence. The bureaucracy was set up essentially for revenue collection —
which makes its role obsolete and questionable in today's changed context.
An important presumption underlying social relations in many countries, including
India, is that production for money is important. This presumption overlooks the contribution
made by children and women for family consumption. Contribution made by them and the
’polluted labour1 to national income have begun to be recognised only recently and that too
partially.
The government has been generally insensitive to the needs of the people. Thus,
fundamental duties of citizens are defined, but not those of the government; a market
economy is being pushed without increasing employment opportunities and purchasing
power of the people; the poor are viewed not as citizens, but as ’ target groups' to be lifted
above a conveniently defined ' poverty line'; programmes are designed, not to genuinely
empower people but by way of sops, so that people may be prevented from organising and
asserting themselves; if the Dalits — who are guaranteed equality under the constitution —
assert themselves and demand the right to equality, it is dubbed as a 'law and order problem',
but the process of generation of thousands of crores of rupees worth of black money is not
viewed as creating a law and order problem; while there is talk of empowering people, there
is increasing centralisation in the name of globalisation; the products being exported come
from unorganised women and child labour and contract labour, while the rich reap the
benefits of the export drive; new laws are being contemplated to discipline industrial labour
while a vast section of unorganised labour remains outside the purview of industrial security;
although elections to the PR institutions are technically compulsory every five years, there is
a convenient clause which facilitates postponement of the elections if the law and order
situation is not conducive. Thus, the functioning of the PR institutions has to be viewed
against the contradictions that exist between precept and practice.

Tracing the background of the new economic policy, S.L. Shetty put forth the hypothesis
that an effective decentralisation in administration is possible only if there is a decentralised
pattern of administration. And the new economic policy, given its nature and time frame, the
6

persons implementing it and the perspective with which it is implemented, is sure to reinforce
the process of centralisation rather than lead to decentralisation.

In support of his hypothesis Shetty noted that the policy of globalisation was introduced
in India at the behest of the multi-national agencies and imposed by the government and
bureaucracy without either professional inputs from the Planning Commission or wide
debate and discussion among the people.
In the new economic scenario, there is an aggressive dependence on consumer goods for
reviving the economy and to earn more revenue. The emphasis is on conspicuous consumption.
Following a sharp reduction in duties, imported luxury goods are flooding the domestic
market and the import of gold and silver has increased from 160-170 tonnes to over 240 tonnes
during the past 3 years. These developments have little meaning for the poor. Market
economy is being encouraged while the masses do not have the requisite purchasing power
to reap the benefits of liberalisation. Government support to the social sector is being reduced.
The massive poverty has been compounded by growing unemployment rates. The raging
double digit inflation will hurt the poor much more than the rich. Vulnerable sections,
including agricultural and industrial workers and the small scale industrial sector, have been
left out of the perspective of the new policy. Thus the policy is truly deficient.

Indian labour is not organised strongly enough to oppose the new policy and the
government itself, given its massive balance of payments problem, could not help but
succumb to the pressures of the external agencies. The class character of the Indian society,
the absence of strong local leadership and forfeiture of its social responsibility by the Indian
industrial elite have all combined to allow the new economic -policy to be implemented
virtually unopposed.
Society will have to pay a heavy price for the structural adjustment programme, in terms
of decentralised development. Reduction in import and excise duties, along with concessions
offered on the direct tax front, have reduced the revenue of the central government. Considering
that the local self-government (LSG) institutions have all along depended heavily on central
government transfers for resources, the latter's dwindling resources would imply a curtailment
of its ability to make such transfers. The result would be that the LSGs may become starved
of funds.

Dwelling on the theme, 'Contours of a Health Policy in PR' Debabar Banerji noted that
health policy formulation, though primarily a political process, has important technological,
managerial, epidemiological and sociological dimensions and this requires a high degree of
inter-disciplinary competence. Absence of such competence has often led to gross distortions
in the policies. The recent efforts of the World Bank to prescribe health policies for countries
undertaking structural adjustment programmes provide examples of such distortions,
reflected by a disproportionate stress on financial aspects to the neglect of key sociological,
technological and managerial considerations. The Indian government has meekly accepted
the World Bank prescription of haphazard budget cuts, expansion of the market for the private
sector, cost recovery from tertiary hospitals and patently defective categorical (special)
programmes for communicable diseases, including AIDS. The World Bank has favoured
further concentration and centralisation of power with the Union Health Ministry.

The idea of involving people in the management of their own health evolved nearly five
decades ago in India. The Health Sub-committee of the National Planning Committee of the
7

Indian National Congress (1948) visualised that the bulk of the problems faced by the rural
population can be attended to by imparting short training to persons selected from among
the population of the village. This idea was to form the basis of the Community Health
Volunteers' scheme formulated decades later by the Janata Government in 1977.
The 1940s also saw the Bhore Committee (1946) draw up an ambitious blueprint for
health service development for independent India. The Bhore Committee showed an astonishing
foresight and among others, called for total population coverage, particularly of the unserved
and under-served, in rural areas only, provision of community health services in an integrated
form, focus on prevention, state funding of services, community involvement and inter
sectoral action for health promotion.
The reports of the two Committees had thus anticipated the ideas contained in the Alma
Ata Declaration of 1978 and the National Health Policy (NHP) of 1983. The NHP contained
policy decisions for large scale transfer of knowledge, simple skills and technologies to Health
Volunteers, selected by the community and enjoying their confidence; positive efforts to build
up individual self-reliance and effective community participation; and back-up support to
primary health care through a well-worked out referral system. However, several socio-'
political developments have prevented the implementation of these laudable policy
pronouncements.

The NPIP document drew attention to the ills plaguing the health service during 1947-82.
According to the NHP, the existing situation has been largely engendered by the adoption of
western models which are inappropriate and irrelevant to the real needs of our people and
their socio-economic conditions. The hospital-based, disease- and cure-oriented approach
has provided benefits to the upper crust of the society, especially those living in urban areas.
The increased acceptance of this approach has been at the cost of providing comprehensive
primary health care services to the entire population, whether residing in the rural or urban
areas. The continued emphasis on curative approach has led to the neglect of preventive,
promotive, public health and rehabilitative aspects of health care. The existing approach,
instead of improving awareness and building self-reliance, has tended to enhance dependency
and weaken the community's capacity to cope with its problems. The prevailing policy
pertaining to training and education of medical and health personnel has resulted in the
development of a cultural gap between the people and those who provide care. As Banerji
observed, the gross defects mentioned in the NHP document above are very much there
twelve years after the declaration of the NHP and have, in some cases, worsened.

In formulating a health policy in PR, a number of issues have to be taken into account.
First and foremost, it has to be assumed that, as envisaged in the constitutional amendment,
PR will be implemented, at least to some extent, by the state governments. That there will be
a wide degree of variation in the levels of democratisation in different states should also be
taken into consideration. Further, other developmental activities, which are implemented by
the PR institutions will also have an impact on health through linkages.. As the implementation
of PR will be a sequential process, a health policy should also have provisions for changes with
changing conditions. As a result, Banerji envisages a short term policy as different from a long
term policy. A fundamental premise of the suggested policy is that an alternative health policy
will not be successful unless it has been demonstrated that it can offer a workable way of
alleviating people's suffering with the available resources and is perceived by the people to
be superior to what has been practised. This implies subordination of medical technology
to the people.
8

• u Jadhav Gadgil and Seshagiri Rao made a forceful plea for conserving bio-diversity
with the involvement of the local population, whether they are tribals or fisherfolks or nomads
and shepherds. They suggested a system of positive incentives to maintain a high level of bio
diversity in the entire range of the country.

According to Gadgil and Rao, state-sponsored conservation efforts have been narrow
and treat people as irrelevant or, worse still, enemies of conservation programmes. They
questioned the notion that bio-diversity can be protected by force.
The new paradigm that is gaining acceptance emphasises conservation of the entire
spectrum of bio-diversity, not just tigers, rhinos or teak or deodhar trees, but seemingly
insignificant plants, animals and micro-organisms which may have immense medicinal and
commercial value. India is still a biomass - based civilisation, with a sizeable number of
people dependent on fuelwood, fodder, building material such as bamboos, medicinal herbs,
wild fruit and fish gathered from their own immediate surroundings. The only way to
conserve their tradition of ecological prudence and knowledge about their own environmental
resources is to create a system of positive incentives to effectively maintain the bio-diversity
heritage.
According to Gadgil and Rao, village settlement/gram sabha, or the assembly of all
adults in the settlement will have to be the focal unit of a reward system to encourage
maintenance of as high a level of distinctive elements as possible, within the territory of the
village settlement. Rewards for custodianship of bio-diversity and knowledge of its use may
primarily come to the village settlement community. As the village settlements stand to gain
in the long run, they are likely to organise sustainable use patterns for local lands and waters
and manage them in such a way as to enhance their bio-diversity value. Here it is absolutely
essential that they should have adequate authority to exclude outsiders and to regulate
harvests by in-group members as well as an assurance of long term returns from restrained use
of resources for such a system to operate efficiently.

While additional rights of access to publicly held resources may serve as positive
incentive for making prudent use of public lands and waters, it may be inadequate to promote
maintenance of bio-diversity instead of leading to profitable monoculture. Hence the need for
a system of suitably devised additional rewards to individuals participating in these efforts
or village/settlement communities linked to the levels and value of bio-diversity within their
territory. Rewards could also be in the form of fees for collecting genetic resources or some
piece of knowledge relating to the use of bio-diversity from the territory. One could also think
of royalties from commercial application of some elements of bio-diversity. The governments
— both central and state — could create a National Bio-diversity Fund which should be
devoted entirely to rewarding village/settlement level local communities and individuals for
their contribution to the ongoing maintenance of bio-diversity and development of knowledge
and use of this bio-diversity. The system of monitoring bio-diversity level, according to
Gadgil and Rao, has to cover the territory of each and every village community. Obviously
this has to be launched as a massive decentralised effort mobilising our entire population.
This would offer a great opportunity for developing a symbiotic relationship between the
informal folk knowledge systems like Ayurveda, Siddha and Unani medicine as well as the
modern scientific knowledge.
Krishna Raj wondered whether it would be correct to put all our eggs in the Panchayati
Raj basket. In this context, there was general agreement that it would be necessary to identify
9

entry points or areas which are best suited to handling at the PR level and that health could
be one of the most important.

According to Antia , both technologically and sociologically, health lends
itself to
low cost delivery. Most health care is within the capacity of the people to manage at .the local
level as evidence from China and Cuba proves. The medical profession has mystified health
and appropriated the people's role. Health care is fast turning into an industry, aided by the
multi-national agencies and a growing drug industry. The system is also characteiised by a
techno-managerial-bureaucratic approach and has alienated the very people it is supposed to
serve. It is important to remember at thisjuncture that health has all along been operating
under a highly centralised environment.
Seshagiri Rao pointed out that under the existing system, health has a strong central
component. Expert teaching and research facilities at medical institutions and bulk production
of drugs in large urban centres for distribution in the rest of the country are two examples of
this. The advantages of some of these features of centralisation should not be overlooked
altogether, nor should the importance of the centre as an overall coordinating agency be
dismissed. An attempt should be made to modify the working of the system suitably and
complement it through decentralisation, wherever feasible.

Jesani expressed doubts as to whether it was possible for a rural community to be selfsufficient in running a health care system. Studies have revealed that an element of subsidy
is essential to sustain the rural health care delivery systems.

Kavadi drew attention to the growing presence of the private sector in health care. In a
democracy the linkages between private and public sector and the nexus between these and
the politicians and the bureaucracy cannot be ignored.

Surveys by the National Sample Survey Organisation (NSSO) and the National Council
of Applied Economic Research (NCAER) have established that poor households incur heavy
debts in order to meet their health expenditure. The remedy, according to Antia, lies in the
provision of affordable health care at the local level. Further, he questioned the sanctity of
the district as the unit of health delivery, which should be decentralised further. Padma
Prakash, however, refuted the view that only primary health care should be provided at the
village level. The dramatic decline in maternal mortality when babies are delivered
institutionally underscores the need for making available a more varied and higher level
health care at this level.
An important issue that cropped up repeatedly related to the inadequate
financial
base of the PR institutions. In many states, PR institutions have the power to levy taxes on
land, fairs, markets, rural roads and the use of community assets, but such self-raised
resources are woefully inadequate to meet the requirements of the PR institutions. As a
result, these institutions are heavily dependent on the government for transfers in terms of
grants and this jeopardises their autonomy. It is, therefore, incongruous to talk of transferring
power to people's institutions without ensuring financial autonomy and adequacy.

Gulati pointed out that in 1992-93, the Kerala state budget was Rs. 4500 cr. of this, the
total allocation to over 1000 village panchayats amounted to a meagre Rs. 200 cr. This amount
included a major transfer of Rs. 80-85 cr. under the Jawahar Rozgar Yojna. The resources that
panchayats can raise on their own came principally from professional tax, entertainment tax,
etc.
10

Desarda noted that in the case of Maharashtra, salaries took away a major chunk of the
resources available with the panchayats, leaving very little money for maintenance or
improvement of services. Professional tax in Maharashtra is with the state government.
Though the panchayats are eligible for levying land tax, sugarcane growers are often exempted
from paying this tax. This is just one example of how powerful lobbies tend to erode the
financial base of the panchayats.
Krishnaswamy pointed out that the panchayats in Karnataka were heavily dependent on
devolution from above as they were required to raise only about 10% of their finances. At the
mandal level, the panchayats had power to levy property tax and local cesses and at the village
level, education cess was leviable by the panchayats. ZPs were not given any specific budget
of their own except what come from the centre via the state government for schemes to be
executed within the ZP jurisdiction. But PR institutions were allowed to raise certain resources
e.g. through auctioning of the right to fish in local ponds and tanks, royalty on building
materials, etc. Large amounts of transfers were for specific purposes, thus restricting
flexibility in expenditure. No panchayat could draw more than Rs. 15000 per month from the
Mandal Panchayat fund. Thus, the available resources were limited and panchayats re.ceived
no specific share in taxes.
An issue that was raised several times in the course of the discussion related to the
question of the panchayats' capacity for decentralised planning. Micro-planning at the PR
level presupposes that people are knowledgeable not only about local needs and availability
of resources, but are also capable of formulating consistent plans that are of relevance to their
developmental needs and of monitoring them. In this context, Krishnaswamy pointed out
that the 1983 Act of Karnataka provided for the establishment of a planning cell to formulate
plans on the basis of schemes suggested by Mandal Panchayats. However, the planning cell
consisted of only a statistical officer who was not well-versed in the concept and techniques
of planning. Further, the Mhndals utilised whatever ideas came from the villages to indicate
priorities, but were not equipped to go into the details regarding resource availability,
resource mobilisation, etc. The L.C. Jain Committee, which was appointed to look into the
working of decentralised planning in Karnataka, did bring out a report suggesting a time
frame, collection of data on resources, etc., but the Committee's report was not treated with
the seriousness it deserved.

Similarly, in Kerala when the Left Front was in power, it was decided to include within
the state plan the amount that would go to the VPs. Besides, an attempt was also made to
include in the VIII Plan as well as the Annual Plans areas which would cover possible
programmes which could fall under the jurisdiction of PRs. Out of the Rs. 1000 cr. earmarked
for Annual Plans, it was assumed that 15-20% would be the share of the PR institutions and
the local governments were accordingly asked to formulate plans. Thus, Kerala had gone one
step ahead of West Bengal, where the Panchayats were not actually involved in the formulation
of plans. It became evident during the process of plan formulation that an important first step
would be to take stock of the resources available with the PR institutions. Unfortunately, the
process of decentralised planning came to an abrupt end with the change of the state
government.
Doubts regarding people's capacity for planning were quelled by several speakers,
including Mutatkar and Awasthi, who cited examples of the ordinary people's organisational
and resource management capabilities as reflected in buildin
les, or organising marriage

- P.O
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feasts and village fairs such as the Kutnbh mela or protecting their environment. The important
thing is people's perception of their own role. Once they perceive a certain activity as being
beneficial to them, the necessary organisational framework would emerge automatically.
Here, Raghuram mentioned how women have demanded drinking water and creches in
Karnataka and people have managed buffer stocks of food in Orissa when delivery under the
Public Distribution System has fallen short.

Several speakers pointed out that legislation on the delegation of power to local bodies
had to face several hurdles. The state Governor, and then the President, have to give their
assent to the PR Bills before they are finally enacted as law. Though it is only a formality, the
concerned state governments have to establish that the state bills have not inad vertently.
violated any constitutional provision.
The problem of delineating responsibilities will have to be solved. For exampl e, would
teachers be transferred to ZP or Panchayat administration or would they continue under
state government ? Would they report to their superiors in the education department or in the
ZP ? Who will recruit these officials or pay their salaries? What role would each of the bodies
have in policy-making and implementation? If fresh recruiting is made for local bodies
administration there would be a further increase in the size of the already unwieldy bureaucracy.
This will be costly and redundant as the staff would be duplicating the work done at district/
state levels.
Awasthi struck a note of caution when he pointed out that PR has come into focus not
because it is supported by people's demand or political will or commitment on the part of the
elite but due to the narrow exigencies of the political class. In a situation where even
complaints have to be channelised through the already powerful district Collector, it cannot
be expected that PR would become a powerful tool for empowering people.

The NGOs have a crucial role to play in mobilising people and changing their perception.
People are often unaware of their rights and entitlements. NGOs should cease to act as
extensions of the government. As Abraham pointed out, the richness of the NGO network
lies not in their individual capacity but in the information that flows from one NGO to another.
Given the professional expertise that they command, they must also help demystify health,
besides exerting pressure on the government to act rationally. Scattered experiments successfully
carried out by NGOs should be given to the government for suitable modification and
replication on a wider scale. The participants deplored the tendency of the NGOs to operate
in highly developed areas where the necessary infrastructure already exists and other NGOs
are also working. Speakers also noted that NGOs have often side-lined and overlooked the PR
institutions and dealt with government officials and politicians directly in a bid to further
their own interests. Ramesh Awasthi and several others felt that NGOs play an important
role in the dissemination of information. Information is a powerful tool, essential for creating
awareness on people's rights and, equally importantly, in dispelling myths and demystifying
medicine. In this connection, representatives of the NGOs met on 11 April to explore the
possibilities of creating an information network.

In the ultimate analysis, problems and hurdles notwithstanding, the PR system has
worked reasonably well in states like West Bengal, Kerala and Karnataka. The Act itself is a
decisive first step towards empowering people, especially women and backward classes.
Though problems may have to be encountered initially eventually the newly empowered
groups will become a force to reckon with. The PR system offers the necessary framework
towards this end; it is for us to make it workable .
12

EWCHmW RAJ AND HEALTH
This report documents the proceedings of a seminar organized by the Foundation for Research
in Community Health, in April 1994.
It brought together doctors, social scientists, economists, political scientists, civil servantsand
social workers to discuss threadbare the experiences of Panchayati Raj. The discussions focussed on
the problems and potential of making Panchayati Raj an effective mechanism whereby the common
people can articulate their concerns and take control over their own lives.

The areas wherein the Panchayati Raj institutions can play an effective role in the process of
decentralization were pinpointed, health being one of the most important amongst these. The
importance of public information and the effective role that NGOs can play in making Panchayati Raj
a living reality were also stressed.
This document should be of interest to all those who are committed to the concept of
decentralization in development.

3B0OT TO
The Foundation for Research inCommunity Health (FRCH)isa non-profit voluntary organization
which carries out research and conducts field studies, primarily in rural areas, to gain a better
understanding of the socio-economic and cultural factors which affect health and heal th care services.
It was established in 1975.

With its staff of doctors, social scientists, economists, management and documentation specialists,
FRCHis trying to determine the reasons as to why health care does not reach everybody particularly
the underprivileged. It is also attempting to evolve cost-effective alternative strageties which can be
utilized on a country-wide scale.
FRCH’s larger aim is to demystify medicine through wider dissemination of knowledge on
health and illness and to create a people's health movement.

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