ArticleBMC health services research2025
How communitization begets and endures sarkarikaran: a witnessed history of community action for health in India's national rural health mission.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The legacy of Community Action for Health (CAH) in India traces back to the global momentum for primary health care galvanized by the Alma Ata Declaration and post-World War II social movements. In 2024, the World Health Assembly endorsed a resolution on institutionalising CAH and other forms of social participation as a core pillar of health reform. The Indian experience of institutionalising CAH under its erstwhile National Rural Health Mission offers an example of sustained national-scale implementations of CAH globally, yet its lessons-both successes and blind spots-remain under-analysed. This paper aims to fill that gap by critically examining the trajectory of CAH since 2005 and exploring its implications for the operationalization of the SPH Resolution. In 2021, two virtual Witness Seminars and four in-depth interviews were conducted with leaders of Civil Society Organizations (CSOs), program implementers, and policy decision-makers involved in the institutionalization of Community Action for Health (CAH) under the National Rural Health Mission (NRHM). Participants included. Seminars and interviews explored key events, actors, processes, and contextual factors that shaped the evolution of CAH. All sessions were fully transcribed and analysed using ATLAS.ti (version 22). Our analysis of the evolution of CAH in India suggests four phases - leading to and flowing away from governmentality. While initially communitization involved collaborative dialogue, debate and system redesign, pilots of CAH rolled out across Indian states with varying strategies, ownership, and stakeholdership. Roles of community began to shift into that of agents and providers as part of "sarkarikaran" or governmentalization of community processes. A final phase suggests that like flowing water, CAH may continue to reconfigure state-society relations in the wake of emerging challenges, less formalised, more embedded interactions. This suggests that institutionalising, standardizing and centralising CAH is neither lasting, nor desirable.
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