The following report describes a qualitative study of recent changes to the health system in India. This country’s health system is moving toward more decentralized operations and increased decision making at the state level. These changes will require state governments in India to plan and manage resources more deliberately. States will need to decide how to allocate newly available funds This means residents of each state may start to see changes in the delivery and quality of healthcare services.

ACCESS Health International conducted the study to investigate four main issues: the drivers behind the devolution process; how this process might affect allocation of health services funds; how much accountability states will have to the central government for their spending; and whether state governments are able to manage these changes. Twenty stakeholders—from the central government, think tanks, and three states with different socioeconomic profiles—were interviewed, and transcripts were analyzed qualitatively to identify main themes.

The study shows that while there is a good baseline capacity for managing devolution, capacity across states differs, and technical assistance will be helpful for states that have less management level infrastructure in place.