Old priorities and new agenda of public health in India: is there a mismatch?

Structural adjustment programs and health sector reforms in India create new agenda in health services. The aim of this study is the analysis of the mismatch between the new health services agenda and epidemiological priorities, and exploration of the possible alternatives, such as decentralization. Analysis of the disease pattern, health, and demographic indicators versus the pattern of investments and policy changes was performed. The possible alternatives were explored by the study of decentralization process attempted in Kerala, by anthropological field work and examination of primary documents. The post-reform period has witnessed a rise in the cases of communicable diseases and an increase in the frequency of epidemics in different parts of the country. The infant mortality rate has risen or decline has slowed down in many states. The new agenda, which includes gradual withdrawal of the State in the provision of health services and the process of privatization, has already been initiated in the country as a part of health sector reforms. The process of decentralization in Kerala was examined to highlight the role of people's planning in health under growing conditions of mismatch between the epidemiological priorities and new agenda. The new agenda could pose a serious threat to effective implementation of public health programs including control of communicable diseases. Public health programs and allocation of resources need to be rooted in the epidemiological and social context. The process of decentralization attempted in Kerala could be used as a tool to achieve this aim.