Understanding Decentralised Healthcare Services: Beneficiary and Provider Experiences from Bilaspur, Chhattisgarh

Abstract

Decentralisation in healthcare has become a pivotal component of public health reform in India, particularly within the framework of the National Rural Health Mission, now integrated into the National Health Mission. As a governance strategy, decentralisation seeks to enhance efficiency, equity, and participatory decision-making by shifting authority and resource control closer to the community level. This review paper critically analyses the decentralisation of health services in the Bilaspur district of Chhattisgarh—a region marked by a substantial tribal population, challenging geographical conditions, and persistent health inequities. The study employs a dual-perspective approach, incorporating both beneficiary and provider viewpoints, while drawing upon national health policies, state-level reform initiatives, and field-based innovations. Empirical and policy evidence demonstrates that decentralised models such as the Mukhyamantri Haat Bazaar Clinic Yojana and the integrated rural health interventions of Jan Swasthya Sahyog have substantially improved the accessibility, utilisation, and acceptability of healthcare services in remote tribal areas (Jan Swasthya Sahyog, 2024; Government of Chhattisgarh, 2019). Furthermore, community-based monitoring mechanisms and local governance institutions, including Village Health, Sanitation and Nutrition Committees and Rogi Kalyan Samitis, have contributed to enhanced accountability and system responsiveness. Nevertheless, the effectiveness of these decentralised structures remains constrained by persistent challenges such as shortages of skilled human resources, limited administrative and technical capacity at the local level, and fragmented financial flows. The findings of this review underscore the imperative to strengthen institutional capacities, ensure meaningful fiscal devolution, and foster authentic community participation in order to realise the transformative potential of decentralised health governance in districts such as Bilaspur.