Taking an Ecosystems Approach: Support for Advocacy Training Initiatives’ (SATHI) Public Health Work in India

Delivering accessible, inclusive and high-quality health services in India is both technically challenging and politically complex. India’s public health services have been highly decentralized for more than a decade, though the central government still plays a critical role. Thus the management and accountability for health services are spread across multiple layers of institutions, from the village Gram Panchayat councils to state and central government ministries. The state of Maharashtra is one of India’s most powerful economic engines. Yet many social groups in Maharashtra lack access to quality healthcare. Despite India’s commitment to the principle of universal access, the state government spends less than 4 percent of its budget on health, poor individuals are often little choice but to seek expensive private healthcare.