Comparing apples with apples: A proposed taxonomy for "Community Health Workers" and other front-line health workers for international comparisons.

This paper proposes a taxonomy for Community Health Workers (CHWs) and others engaged in front-line community health activities, encompassing formally-employed workers extending government primary health care (PHC) service delivery as well as a range of other actors with roles at the nexus of government PHC and communities. The taxonomy is grounded in current definitions from the World Health Organization and the International Labor Organization, and proposes some refinements for future iterations of guidance from these agencies. The designation, "Community Health Worker" is currently used to cover a broad range of roles.

Individual interventions, collective lessons: Developing mid-range theory on women's groups to improve health.

Background: Interventions with women's groups have been widely implemented to improve health outcomes in low- and middle-income settings, particularly India. While there is a large evidence base on the effectiveness of single interventions, it is challenging to predict whether a women's group intervention delivered in one setting can be expected to work in another.

Methods: We applied realist principles to develop and refine a mid-range theory on the effectiveness of women's groups interventions, summarised key lessons for implementation, and reflected on the process.

Embedding rapid reviews in health policy and systems decision-making: Impacts and lessons learned from four low- and middle-income countries.

Background: Demand for rapid evidence-based syntheses to inform health policy and systems decision-making has increased worldwide, including in low- and middle-income countries (LMICs). To promote use of rapid syntheses in LMICs, the WHO's Alliance for Health Policy and Systems Research (AHPSR) created the Embedding Rapid Reviews in Health Systems Decision-Making (ERA) Initiative. Following a call for proposals, four LMICs were selected (Georgia, India, Malaysia and Zimbabwe) and supported for 1 year to embed rapid response platforms within a public institution with a health policy or systems decision-making mandate.

Hysterectomy and women's health in India: evidence from a nationally representative, cross-sectional survey of older women.

Background: Hysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life.

Effectiveness of a community-based education and peer support led by women's self-help groups in improving the control of hypertension in urban slums of Kerala, India: a cluster randomised controlled pragmatic trial.

Background: With less than 20% of people with hypertension achieving their target blood pressure (BP) goals, uncontrolled hypertension remains a major public health problem in India. We conducted a study to assess the effectiveness of a community-based education and peer support programme led by women's self-help group (SHG) members in reducing the mean systolic BP among people with hypertension in urban slums of Kochi city, Kerala, India.

Methods: A cluster randomised controlled pragmatic trial was conducted where 20 slums were randomised to either the intervention or the control arms.

The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India.

Background: Direct-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.

Assessing the reliability of phone surveys to measure reproductive, maternal and child health knowledge among pregnant women in rural India: a feasibility study.

Objectives: Efforts to understand the factors influencing the uptake of reproductive, maternal, newborn, child health and nutrition (RMNCH&N) services in high disease burden low-resource settings have often focused on face-to-face surveys or direct observations of service delivery. Increasing access to mobile phones has led to growing interest in phone surveys as a rapid, low-cost alternatives to face-to-face surveys. We assess determinants of RMNCH&N knowledge among pregnant women with access to phones and examine the reliability of alternative modalities of survey delivery.

Avoiding the Road to Nowhere: Policy Insights on Scaling up and Sustaining Digital Health.

Digital health solutions offer tremendous potential to enhance the reach and quality of health services and population-level outcomes in low- and middle-income countries (LMICs). While the number of programs reaching scale increases yearly, the long-term sustainability for most remains uncertain. In this article, as researchers and implementors, we draw on experiences of designing, implementing and evaluating digital health solutions at scale in Africa and Asia, and provide examples from India and South Africa to illustrate ten considerations to support scale and sustainability of digital health solutions in LMICs.

Examining the reach and exposure of a mobile phone-based training programme for frontline health workers (ASHAs) in 13 states across India.

Mobile phones are increasingly used to facilitate in-service training for frontline health workers (FLHWs). Mobile learning (mLearning) programmes have the potential to provide FLHWs with high quality, inexpensive, standardised learning at scale, and at the time and location of their choosing. However, further research is needed into FLHW engagement with mLearning content at scale, a factor which could influence knowledge and service delivery.

Assessing exposure to Kilkari: a big data analysis of a large maternal mobile messaging service across 13 states in India.

The Kilkari programme is being implemented by the Government of India in 13 states. Designed by BBC Media Action and scaled in collaboration with the Ministry of Health and Family Welfare from January 2016, Kilkari had provided mobile health information to over 10 million subscribers by the time BBC Media Action transitioned the service to the government in April 2019. Despite the reach of Kilkari in terms of the absolute number of subscribers, no longitudinal analysis of subscriber exposure to health information content over time has been conducted, which may underpin effectiveness and changes in health outcomes.

A tale of 'politics and stars aligning': analysing the sustainability of scaled up digital tools for front-line health workers in India.

Introduction: India has become a lighthouse for large-scale digital innovation in the health sector, particularly for front-line health workers (FLHWs). However, among scaled digital health solutions, ensuring sustainability remains elusive. This study explores the factors underpinning scale-up of digital health solutions for FLHWs in India, and the potential implications of these factors for sustainability.

Adolescent health in the Sustainable Development Goal era: are we aligned for multisectoral action?

Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment.

Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling.

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS).

Counseling Is a Relationship Not Just a Skill: Re-conceptualizing Health Behavior Change Communication by India's Accredited Social Health Activists.

The capacity for India’s community health workers—accredited social health activists (ASHAs)—to promote healthy behaviors must be understood within the health system and community context. Their ability to influence health behaviors depends on the strength of their relationships with families and support they receive from the health system.

Novel approaches to measuring knowledge among frontline health workers in India: Are phone surveys a reliable option?

Background: In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs' knowledge is limited, yet is a critical determinant of the quality of health services provided.

What makes primary healthcare facilities functional, and increases the utilization? Learnings from 12 case studies.

Background: The last few decades have witnessed a number of innovative approaches and initiatives to deliver primary healthcare (PHC) services in different parts of India. The lessons from these initiatives can be useful as India aims to strengthen the PHC system through Health and Wellness Centers (HWCs) component under Ayushman Bharat Program, launched in early 2018.

Materials And Methods: Comparative case study method was adopted to systematically document a few identified initiatives/models delivering the PHC services in India.

Lenses and levels: the why, what and how of measuring health system drivers of women's, children's and adolescents' health with a governance focus.

Health systems are critical for health outcomes as they underpin intervention coverage and quality, promote users' rights and intervene on the social determinants of health. Governance is essential for health system endeavours as it mobilises and coordinates a multiplicity of actors and interests to realise common goals. The inherently social, political and contextualised nature of governance, and health systems more broadly, has implications for measurement, including how the health of women, children and adolescents health is viewed and assessed, and for whom.

Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol.

Background: Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes.

India's health and wellness centres: realizing universal health coverage through comprehensive primary health care.

In common with other countries in the World Health Organization South-East Asia Region, disease patterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases. This epidemiological transition has been a major driver impelling a radical rethink of the structure of health care, especially with respect to the role, quality and capacity of primary health care. In addition to the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and most vulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on an ambitious programme of transforming India's 150 000 public peripheral health centres into health and wellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of 2022.

Taking stock of 10 years of published research on the ASHA programme: examining India's national community health worker programme from a health systems perspective.

Background: As India's accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale.

Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW-health systems interface framework.

Village Health Sanitation and Nutrition Committees: reflections on strengthening community health governance at scale in India.

India's National Health Mission constituted Village Health Sanitation and Nutrition Committees (VHSNCs) as a key mechanism for community health governance. Health committees provide citizens with the opportunity to shape health systems and policies. Yet much remains to be learnt on how best to sustain health committees as vehicles for community health governance at scale.

Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India.

Background: Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India.

Future directions for reducing inequity and maximising impact of child health strategies.

Current global child health strategies have reduced wealth based inequities in care seeking for childhood illness, but we need much greater emphasis on equity in strategy design and implementation, say