This paper focusses on the need of intervention of the Gram Panchayat in the arena of universal access of healthcare; and healthcare financing. Although 75% of India's population live in rural areas, there are remarkable inequalities in terms of educational achievements, employment opportunities, purchasing power, and health and its attributes including infant mortality, general morbidity, economic security in terms of assured income earning opportunities, and so on. In this paper, an attempt is made to build up a hypothetical model where universal coverage could be achieved by a multi-tiered insurance system through panchayat with varying degree of subsidization according to the perceived economic vulnerability on the part of the population insured.
The current health situation in India is a sad story of deprivation. Unless one is fobbed off with displays of hi-tech medical care and use of state-of-the-art medical technologies in five star deluxe facilities of a few select urban centers, the tale of utter helplessness and callous carelessness is so apparent that it is now frequently taken as a matter of course. The blatantly paradoxical spectacle of buying and selling of health improvements as consumer goods by the well-off minority in the metros on one hand and the denial of basic health facilities to the vast majority of the population along the length and breadth of the country on the other hardly evokes any comment. This can be well-founded in the Table: Differentials in Health Status.
panchayat system as a form of local self-government has been embodied as an `aspiration' in the 1950 Constitution. In practice, it was devolved to the states for implementation [Datta and Datta 1995]. Almost no action was taken on this matter by any state till the late 1970s and early 1980s when opposition parties were elected to power in some states, notably West Bengal and Karnataka. After a decade of political violence and upheavals, the Left Front (LF), a combine of leftist parties led by the Communist Party of India (Marxist) ( CPI (M)) came to power in 1977 on the promise of vigorous agrarian and political reform. Its agrarian reform program involved forceful implementation of existing tenancy laws that gave security of tenure and a legally stipulated minimum crop-share to tenants, and distributing landholdings above the legally permitted limits from landowners to small and marginal farmers as well as the landless rural poor. In terms of its achievement on both these counts, it is by far the leading state in the country [Gazdar and Sengupta 1995, p 136]. Its political reform program consisted of empowering the three-tiered panchayat system with a gram panchayat (village council) for a cluster of villages at the bottom, a panchayat samiti covering the area of a block, and a zilla parishad for the district. The lowest level of electoral unit in the panchayat system in West Bengal is the gram panchayat, which covers around 10-12 villages totaling around 10,000 residents. It has 15-20 seats of representatives elected every five years. In the 1998 elections, there were 3,226 gram panchayats or village councils in West Bengal with 49,199 members. An electorate composed of around 700 voters elects each member. This village council is headed by a `pradhan' (chief) and an `upa pradhan' (deputy chief) elected from amongst themselves by the gram panchayat members. At the ground level, the village council is a very powerful and influential body, wielding effective control over substantial resources and political power. Above the village council, there is the panchayat samiti at the block level. Each panchayat samiti covers, on an average, about 115 villages and a rural population of about 1,65,736, of whom 1,01,387 are eligible voters. In 1998, there were 329 panchayat samitis in West Bengal with a total of 8,515 members, all elected by the people. An elected `sabhapati' or (president) heads the PS. The once all-powerful bureaucrat at this level, the Block Development Officer (BDO), is now an executive officer to the panchayat samiti. This provides a direct linkage of the panchayats with the administration. It also allows a popularly elected body to exercise some control over the administration. At the highest level, there is a zilla parishad, one for each district. In 1993, there were 16 zilla parishads with 873 elected members. The head of the zilla parishad, the `sabhadhipati', enjoys the rank of a minister of the state government." (Source: Recent Reforms in the Panchayat System in West Bengal: Toward Greater Participatory Governance?; Maitreesh Ghatak, Maitreya Ghatak, Economic and Political Weekly, January 2002) |
