Towards strengthening primary health care: Lessons from a government-civil society collaborative intervention in India

Introduction: The need to strengthen comprehensive primary health care towards ensuring “Health for All” is well established yet operationalizing this has remained a challenge globally as well as in India. Based on a qualitative study of a collaborative initiative between the government and a civil society organization, this article discusses what factors and processes explain successful implementation of primary health care in a remote rural area in central India. Methods: Data were drawn from in-depth interviews (n=27), observations of health facilities including outreach clinics as well as conversations with the staff during these visits (n=17 visits) and document analysis of Minutes of Meetings, Memorandum of Understanding, Project Reports and Government Circulars. Data were collected between December 2022- April 2023. Data were analyzed concurrently with data collection. Suitable themes and sub-themes were identified after juxtaposing different sources of data to construct a story of the initiative keeping a close eye and ear on the role of different actors, contexts, processes and their implications. Results: Our findings show how policy actors’ interpretation of the shared cause of the initiative, ‘experiencing’ contextual and feasible evidence, building and nurturing partnerships across different levels and actors were key to the implementation of this initiative. Additionally, values including equity, community participation, patient centered care and organizational culture were equally central to this effort. Conclusion: Our findings reiterate the central role of the philosophy and values of primary health care in its implementation. These also resonate with the theoretical literature that draws attention to the need to investigate complex intersections of power, actors’ interests, ideas, and contexts in the study of health system policy implementation.