ABSTRACT
This chapter explores relationships between the provision of health care in India and its federal structure of government. Governmental institutions are not neutral; they shape the behaviour and decisions of political actors that directly impact on policy development. In particular, a federal system influences and constrains any government activity – including a public health system – through multiple veto-points, interregional tax competition and regional jurisdictions (Jordan 2008). Sixty-plus years of federalism in India have produced a disorganised health system with mismatched funding among levels of government and a concentration of health care professionals in urban areas. Patterned on the 1946 Bhore Report with its tiers of integrated responsibilities and logical structures, the health system in India is simultaneously centralised and a patchwork of programmes.
