This study examines the impact of decentralised governance on the success of the Indian state of Kerala`s healthcare system. Kerala`s healthcare model, characterised by strong local governance, community engagement and accountability, has consistently contributed to its superior health outcomes, placing it at the top of national health rankings. The state`s decentralised framework empowers local authorities to implement tailored healthcare solutions, fostering responsive and context-specific interventions. By analysing Kerala`s model through the lens of decision space, this study highlights how enhanced accountability and local autonomy have been central to the system`s effectiveness, particularly during public health crises. The findings are that Kerala`s model could serve as a framework for strengthening decentralised governance in healthcare systems nationwide. Policy recommendations include expanding local decision-making authority, improving accountability through social audit committees and providing adequate financial and capacity-building support to local authorities. Additionally, the paper calls for further research on the effectiveness of decentralised governance in healthcare, proposing field-level studies and comparative analyses of different regions. Such research will inform policies aimed at creating a more equitable, resilient and responsive healthcare system across India.