Improving Systems of Accountability in Primary Healthcare -

A study in rural Karnataka, India


Research Team

Co-Investigators: Shirin Madon, LSE and Srinivas Krishna, GSM Academy, Bangalore

Field Researchers:  Lakshmana, K. and Rudresh, P.N.


* The research team gratefully acknowledges the support of the British Academy from 2011-2014


Project Synopsis

Contemporary debates about improving accountability of public service delivery in India and other developing countries have involved two almost distinct directions.  The first relates to the legacy of creating more openness and transparency in health reporting through improved access to information.  India is one amongst many developing countries that has invested in improving systems of accountability by implementing Health Management Information Systems to aggregate information from primary health centre upwards for planning and resource allocation.  In recent years, pilot projects have been implemented aimed at improving the quality of data captured at source by providing mobile phones and hand-held devices to health workers. 

The second direction relates to new mechanisms initiated under the auspices of India’s National Rural Health Mission aimed to improve systems of accountability in primary healthcare through greater community engagement.  The Village Health and Sanitation Committees (VHSCs) were set up to facilitate the regular interaction of local state, political and civil society representatives.   With funding from the British Academy, we are conducting a longitudinal study of 12 VHSCs in Gumballi PHC, Yelandur Taluk in Karnataka through the assistance of two field researchers.  Gumballi PHC is managed by the Karuna Trust, an NGO which has been providing basic healthcare, education and livelihoods to tribal communities in Chamarajnagar district for the past 30 years. 

The main focus of our study so far has been to identify the dynamics within the VHSCs focusing on the social processes of information exchange, usage of discretion and network formation.   Currently, we are also working with the Karuna Trust ( in a VHSC capacity-building exercise supporting the villages to develop a village health plan and participating in a community monitoring exercise.





Draft manuscript Photo gallery

Academic references

Workshop 2012