Trends in rural fiscal decentralisation in India’s Karnataka state: a focus on public health

Main Article Content

Megha Rao
Arnab Mukherji
Hema Swaminathan


For decades, decentralisation reforms have been seen as a powerful instrument by health policy advocates to improve health sector performance in developing countries. In India, the 73rd Constitutional Amendment introduced in 1992 called for strengthening the fiscal autonomy and service delivery capacity of rural local governments. This paper explores how decentralised governance influences public health sector resource allocation, equity and efficiency in rural Karnataka. For this, the authors analysed administrative data published by the Karnataka state government to create tailored standardised performance measures that capture the degree of local governments’ fiscal discretion in implementing public health programmes from 2011–18 at the district level. The findings highlight sector-specific differences in fiscal autonomy, ranging from high local discretion over funds in the nutrition sector to very limited discretion in the medical and public health sector. They also show that decentralised public health funding is not well-targeted to areas of greatest need in Karnataka

Article Details

How to Cite
Rao, M., Mukherji, A., & Swaminathan, H. (2021). Trends in rural fiscal decentralisation in India’s Karnataka state: a focus on public health. Commonwealth Journal of Local Governance, (25), 56-78.
Research and Evaluation (peer-reviewed)
Author Biographies

Megha Rao, Centre for Public Policy

Research Fellow

Centre for Public Policy

Indian Institute of Management Bangalore


Arnab Mukherji, Centre for Public Policy


Centre for Public Policy

Indian Institute of Management Bangalore


Hema Swaminathan, Centre for Public Policy

Associate Professor

Centre for Public Policy

Indian Institute of Management Bangalore



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