Table 5

Analysis of factors contributing to the policy and programmatic reforms of three major programmes in Chhattisgarh

Health and ICDS programmesPublic distribution system
Vision for impact
StatehoodNew policy energy for change created when the state was carved out from Madhya Pradesh. New state formation enabled opportunities for government and civil society to aid the change process through a vision for impact.
Development indicatorsPoverty and high IMR motivated reforms that supported the goal for impact.
Enabling environment
Political leadershipPolitical parties in power until 2018 supported the Mitanin programme and PDS in the state since its inception in 2000.
Political stabilityThe state political leadership remained the same for three consecutive terms between 2003 and 2018 and continued the policy efforts of the former ruling party.
Other political factorsPolitical leaders became interested in the health reforms once the IMR reductions happened in 2003–2004. Beneficiaries of the Mitanin seen as major contributors to the vote bank.Push for reforms in 2007 were spurred by the ruling party’s loss to the opposition in a constituency. PDS beneficiaries seen as major contributors to the vote bank.
Bureaucratic leadershipSeveral health sector programmes (Mitanin, creche programme, an annual child-weighing campaign, and a programme to treat severely malnourished children) received support of bureaucratic leadership at the state and district levels.Computerisation reforms backed by bureaucratic leadership in the department of food and civil supplies.
Bureaucratic capabilitySeveral health sector schemes associated with an able and experienced bureaucracy. Some functionaries of the reform process had the experience of working with reforms in Madhya Pradesh.
Operational capacities
TechnicalRural Medical Assistance Scheme brought in more human resources.Extensive use of technology to make the PDS more efficient and transparent.
FinancialDiverse sources of funding including untied funds, District Mineral Fund (royalty charged by the government for extraction of minerals) and the private sector.
Delivering interventions through platforms
Policy guidanceThe National Rural Health Programme policy framework provided guidance to implementation of health sector reforms. Integrated Child Health Development Services provided guidance to implement nutrition interventions.
ResourcesNRHM enabled financial, technical and infrastructural resources for programme implementation.Centre supported state-led reforms.
Champions and catalysts
Local NGOs and civil societyState Health Resource Centre seen as a major contributor to health sector reforms. A united NGO force helped to scale up the Mitanin programme in a short time period. Special mention of the Adhivasi Adhikar Samiti.Civil society mobilised action to create awareness about the PDS and provided insight.
Right to Food CampaignMobilised action to create awareness about nutrition and support the scale up of the Mitanin programme.Mobilised action to build consumer demand and policy dialogue.
CommunityBoth government and non-government stakeholders have been supportive of the role of community in implementing health and nutrition programmes (several successful innovations have involved the community).Community involved to raise awareness about PDS.
Development partnersEuropean Union provided initial support for the Mitanin program in 2000. UNICEF provided technical support to ICDS since 2005.
Monitoring and evaluation
Monitoring, learning and evaluationData and evaluations carried out by external parties used to inform implementation of programmes.Several social audits led by civil society on PDS used to improve implementation.
  • Sources: Based on perceptions of stakeholder interviews at the state level.

  • ICDS, Integrated Child Development Services, a programme which provides health and nutrition services to pregnant and lactating women,children below 6 years, and adolescent girls through a network of village-level centres; NGO, non-government organisation; NRHM, National Rural Health Mission was launched in 2005 to provide quality health services torural poor with a specific focus on maternal and child health, and provided additional resources to states; PDS, Public Distribution System, India’s food subsidy programme.