Leadership in health services (Bradford, England) · 2026
Evaluating community perceptions of leadership in decentralized governance during public health crisis: a case study from Thrissur district, Kerala (India).
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Vattamparambil Kiran Prakash, Chatterjee Suhita Chopra
Аннотация
PURPOSE: This study aims to investigate how demographic variables - specifically age, gender and income - influenced community perceptions of decentralized governance leadership during the COVID-19 crisis in Elavally Panchayat, Kerala. It explores residents' varied experiences with local service delivery and support mechanisms, revealing disparities in satisfaction and access. The findings underscore the importance of inclusive, adaptive and crisis-responsive local leadership during public health emergencies.
DESIGN/METHODOLOGY/APPROACH: Adopting a mixed-methods approach, this study combined unstructured interviews with elected local self-government leaders and primary health centre staff with a structured household survey. The survey included first 100 household respondents drawn from confirmed COVID-19 cases across all 16 wards. Six dimensions of governance performance were assessed using a three-point Likert scale (Satisfied, Neutral and Dissatisfied). Descriptive statistics and chi-square tests (p < 0.05) were applied to examine demographic variations in satisfaction levels. Qualitative insights from interviews further contextualized and deepened the findings.
FINDINGS: The results indicate significant demographic disparities in perceived leadership effectiveness. Younger adults appreciated digital welfare schemes but felt excluded from local decision-making. Middle-aged residents experienced severe healthcare and livelihood disruptions, while elderly individuals struggled with digital health systems. Women expressed higher satisfaction due to targeted welfare schemes, whereas men cited unmet mental health and economic needs. Lower-income groups reported barriers to accessing essential services. Nonetheless, decentralized governance grounded in trust, equity and participatory approaches enabled an effective, context-specific crisis response.
ORIGINALITY/VALUE: Unlike studies that treat communities as homogeneous, this research disaggregates perceptions, offering policy insights to strengthen equity and resilience in local health governance.
DESIGN/METHODOLOGY/APPROACH: Adopting a mixed-methods approach, this study combined unstructured interviews with elected local self-government leaders and primary health centre staff with a structured household survey. The survey included first 100 household respondents drawn from confirmed COVID-19 cases across all 16 wards. Six dimensions of governance performance were assessed using a three-point Likert scale (Satisfied, Neutral and Dissatisfied). Descriptive statistics and chi-square tests (p < 0.05) were applied to examine demographic variations in satisfaction levels. Qualitative insights from interviews further contextualized and deepened the findings.
FINDINGS: The results indicate significant demographic disparities in perceived leadership effectiveness. Younger adults appreciated digital welfare schemes but felt excluded from local decision-making. Middle-aged residents experienced severe healthcare and livelihood disruptions, while elderly individuals struggled with digital health systems. Women expressed higher satisfaction due to targeted welfare schemes, whereas men cited unmet mental health and economic needs. Lower-income groups reported barriers to accessing essential services. Nonetheless, decentralized governance grounded in trust, equity and participatory approaches enabled an effective, context-specific crisis response.
ORIGINALITY/VALUE: Unlike studies that treat communities as homogeneous, this research disaggregates perceptions, offering policy insights to strengthen equity and resilience in local health governance.