Role of Local Self-Government in Strengthening Public Health Services: A Comprehensive Review

Local self-government (LSG) institutions play a pivotal role in decentralizing healthcare services, enabling community participation, accountability, and context-specific interventions. Strengthening public health systems through local governance is critical for improving accessibility, equity, and efficiency, particularly in diverse and resource-limited settings. This review examines the role of local self-government in enhancing public health services, highlighting best practices, challenges, and policy recommendations for more resilient and inclusive healthcare systems. A narrative review was conducted using literature from electronic databases (PubMed, Scopus, Google Scholar), international reports (WHO, UNDP), and national policy documents published between 2000 and 2025. Evidence was synthesized across thematic areas including primary healthcare, maternal and child health, sanitation, disease control, and emergency preparedness. Findings indicate that local self-government significantly contributes to primary healthcare delivery, maternal and child health programs, immunization, sanitation, nutrition, and epidemic response. Case studies from India, such as the Kerala model and Panchayati Raj health initiatives, demonstrate successful community-centered approaches, while international examples from Uganda, Brazil, and the Philippines highlight the effectiveness of participatory governance, resource allocation, and accountability mechanisms. Challenges identified include financial constraints, human resource shortages, weak coordination, technological gaps, and socio-political barriers. Strategies to address these challenges include strengthening financial autonomy, capacity building, digital health integration, multi-sectoral collaboration, and robust monitoring frameworks. Empowering local self-government institutions through policy reforms, training, and digital integration can enhance healthcare accessibility, equity, and resilience, and integrating lessons from successful decentralized models can inform local-global strategies for sustainable public health governance.