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While the health grants to local governments recommended by Fifteenth Union Finance Commission in the wake of Covid 19 pandemic lays emphasis on the trust-based approach to local governments and decentralization of health, the danger of Mission Creep can undo the potential and effectiveness of the grants to strengthen the primary health care sector. Lack of sensitization towards local governments; the misconception that local governments and its stakeholders are illiterate, weak and corrupt entities; absence of an institutional monitoring mechanism to conduct a follow-up of the recommendations made by the respective Finance Commissions; lack of co-ordination between various Ministries of union and state governments; and the erosion of cooperative federalism can all contribute to health grants falling prey to the vicious cycle of Mission Creep Syndrome.

Highlights • Kerala’s pandemic management has been a decisive test of the “Kerala model of development”. • Behind Kerala’s relative success were robust public institutions, the legacy of the “Kerala model” built over many years. • This pandemic shows that even a participatory social democratic state face tough challenge in managing crises and guaranteeing basic security. • The unhealthy combination of adversarial politics and consensus-based democratic approach led to the surge in Covid 19 infections in Kerala., Kerala, a small state in South India, has been celebrated as a development model by scholars across the world for its exemplary achievements in human development and poverty reduction despite relatively low GDP growth. It was no surprise, then, that the Covid 19 pandemic that hit Kerala before any other part of India, became a test case for the Kerala model in dealing with such a crisis. Kerala was lauded across the world once again as a success story in containing this unprecedented pandemic, in treating those infected, and in making needed provisions for those adversely affected by the lockdown. But as it turned out, this celebration was premature as Kerala soon faced a third wave of Covid 19 infections. The objective of this paper is to examine Kerala’s trajectory in achieving the success and then confronting the unanticipated reversal. It will examine the legacy of the Kerala model such as robust and decentralized institutions and provisions for healthcare, welfare and safety nets, and especially the capacity of a democratic state working in synergy with civil society and enjoying a high degree of consensus and public trust. It will then examine the new surge of the virus and attempts to establish if this was due to any mistakes made by the state or some deficits in its model of “public action” that includes adversarial politics having a disruptive tenor about it. We will conclude by arguing that the Kerala model is still relevant, and that it is still a model in motion.

The Total Sanitation Campaign (TSC), a ‘flagship’ programme of the Government of India, has completed a decade of implementation. The TSC over the period has been able to improve human health and sanitation coverage in the country. The initial success could be attributed to ‘Nirmal Gram Puraskar’. The total sanitation campaign has effectively made use of the village social structures in Kerala to solve the first generation sanitation issues. Disparities could also be seen. As the TSC is on the verge of a positive transformation to a new and broader perspective, and as the state look forward for a new dimension in sanitation concepts over the next five-year plan, it asks for a review on the coverage patterns. This would support the policy-makers to invest in edifying ideals as the nation progress from the TSC to ‘Nirmal Bharat Abhiyan’. The broad objective of the study thus is to assess the impact of sanitation and hygiene coverage in the state. For measuring the outcomes and relative performance in terms of total sanitation provision, seven selected Gram Panchayats of Kozhikode district are considered. To arrive at a robust scenario, a synthesis of a narrative and statistical model was used. An innovative measurement framework known as ‘Total Sanitation Index’ was developed. The index was formulated for comprehending the relative positions of each Panchayat in terms of total sanitation and the results were presented.

Mahatma Gandhi National Rural Employment Guarantee Scheme (NREGS) and Kudumbashree Poverty Alleviation Mission take a different approach to poverty alleviation. When viewed through the lens of capability approach the difference becomes more evident. Both the programmes, through their procedures and outputs, enable the beneficiaries themselves to be the agent of change. People themselves could utilize the opportunities generated by the procedural, output aspect of the programmes to remove their unfreedoms and deprivations to attain their desired functioning for well being. Community development also takes place along with individual development. The convergence of Mahatma Gandhi NREGS and Kudumbashree under the umbrella of the Local Self Government complement each other’s effort in poverty alleviation.

Intervention projects aimed at preventing STD and HIV generally tend to target women sex workers and through them their clients. This approach sees women sex workers as agents of change, with the attendant burden, but has failed to recognise gender issues surrounding sexual health, particularly power relations existing in society. While gender justice is a recognised legitimate concern, the discourse has excluded sex workers from its purview making them the moral 'other'. Sexual health projects implemented currently in different parts of Kerala are not sensitive to gender issues because they mistakenly assume that sex workers are autonomous subjects. In the sexual health project for female sex workers implemented in the Kottayam municipal area some gender issues were tackled with modest success. This paper makes a strong plea for more gender sensitivity in sexual health projects and for men to take their fair share of responsibility for HIV transmission.

This study seeks to examine some initial outcomes of the incorporation of women in local governance, following the introduction of 33 percent reservation of seats for women representatives in local-level political bodies in rural areas of India in 1995. The paper is therefore based on extensive interviews with 27 women, who were elected members of bodies of local governance, i.e, panchayats, of Vaikom Block in Kottayam District, Kerala, the southern-most state of India. Most of the interviewees had acquired knowledge and skills appropriate to elected office during a three year period after assuming office, when the survey was undertaken. It was seen that these women representatives were not able to change the style and practice of the wider political arena, especially of the political parties. In fact, they found the local party machinery, especially of the Leftist parties, exercised considerable control over them, because of which they were unable to function independently or in a non-partisan ma...