MSc DISSERTATION - Development Studies Institute (DESTIN), 1999

Effectiveness of Public Action in Rural Health Service Delivery: A Case Study from Kerala

Supervisor: Dr. John Harriss, London School of Economics (LSE)

Public action studies on Kerala fail to distinguish between the existence of collective action and its effectiveness. Popular explanations for public action in Kerala are educational advancement, historical influence, and political awareness.

Seeking to explore the effectiveness of public action in rural health, the study collated instances of public activism in the 1980s and 1990s in a Kerala village. Drawing upon primary and secondary sources, the study attempted to:

  • examine the role of education in public action
  • identify variables of effective public action
  • assess the role of Kerala newspapers in effective public action.

To understand the role of newspapers at the macro level, a survey of three leading vernacular dailies (three months' editions) was undertaken.

Analysis of public action in Kerala, based on evidence gathered, led to the following conclusions:

  • Education and political awareness facilitate public action by keeping political incentives alive.
  • An explanation for the occurrence of public action must incorporate a constellation of determining factors like availability of exit options, organisational interests, and existence of social capital.
  • Existence of public action does not imply its effectiveness; a distinction is necessary to isolate variables and enhance the value of the mechanism.
  • Nature of the demand, duration of public action, availability of exit opportunities, excessive public action, nature of intervention of political parties, and violence are some variables that can be used to predict the effectiveness of public action.
  • Newspapers in Kerala contribute to the effectiveness of public action in health, but well below their potential. On a positive note, they raise health concerns and provide space for 'microphone' stories. At the same time, preference for sensational news, political apathy in the matter of rural health, and urban bias limit the effectiveness of newspapers.

Full Text of Dissertation
World Development Report 2004
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Copyright © 1999 Ashok R Chandran