Strengthening the Fabric

Federalism, Decentralisation, and India's Healthcare Imperative

Abstract

The Indian federal structure has been shaped by a history of central planning and concentration of power at the federal level. This concentration of power has left state and local government in a subsidiary position. The healthcare and social policy literatures stress that a number of aspects of a federal system can influence and constrain the public healthcare system, namely, multiple veto points, interregional tax competition, and regional jurisdictions. This paper delves into the intricate relationship between federalism, decentralisation, and India's healthcare landscape. Against the backdrop of a diverse and complex healthcare system, it examines the imperative for effective governance structures in addressing the nation's healthcare challenges. By analysing the distribution of responsibilities between the central and state governments, the paper explores how federalism shapes healthcare policies, resource allocation, and service delivery across India's vast and heterogeneous population. Ultimately, this paper offers insights and recommendations to inform policy discourse and drive transformative reforms towards achieving universal healthcare coverage and improving health outcomes for all citizens.