In recent years, the role of community engagement in transforming public health outcomes has received increasing attention from researchers and policymakers worldwide. A groundbreaking study published in the International Journal for Equity in Health sheds new light on how women’s health collectives, fostered by India’s National Urban Health Mission (NUHM), have become pivotal in promoting community participation and improving health equity in the state of Chhattisgarh. This realist evaluation offers a technical and nuanced analysis of the mechanisms and contextual factors driving the success of these collectives, documenting a transformative journey rooted in grassroots empowerment and systemic change.
The study’s core revolves around women’s health collectives, which are community-based groups formed to advocate for and actively support women’s health and well-being. These collectives function not only as platforms for health education but also as engines for social mobilization, addressing deeply entrenched structural barriers such as gender inequality, inadequate access to healthcare, and socioeconomic disenfranchisement. Leveraging qualitative and quantitative data, the researchers employ a realist evaluation framework, which moves beyond simplistic cause-effect paradigms to examine how context interacts with mechanisms to produce varied outcomes in community health initiatives.
At the heart of this research lies the National Urban Health Mission, an ambitious program initiated by the Indian government designed to strengthen urban health infrastructure, with a special focus on vulnerable populations including women and children. NUHM’s model promotes decentralization and fosters partnerships between government agencies and local communities, setting the stage for women’s health collectives to emerge as key agents in the health ecosystem. The evaluation conducted in Chhattisgarh—a state marked by rural-urban disparities and tribal populations—provides valuable insights into the adaptability and scalability of such community-driven interventions in diverse socio-cultural settings.
One of the central findings highlights how women’s health collectives serve as critical nodes for knowledge dissemination and behavioral change communication. Through regular meetings, locally tailored health campaigns, and participatory decision-making, these collectives empower women with the information and agency needed to navigate health services more effectively. The study reveals a complex interplay of social capital, trust, and collective efficacy as essential mechanisms, which, when activated in climates of supportive governance and resource availability, yield meaningful improvements in health service utilization and outcomes.
The realist evaluation approach enables the researchers to unpack the contingencies influencing collective effectiveness. For instance, in areas with strong local leadership and government collaboration, collectives demonstrate higher levels of sustained engagement and innovation. Conversely, in contexts marked by political instability or resource constraints, the collectives face challenges in maintaining momentum, underscoring the importance of stable institutional support. This nuanced understanding provides a roadmap for policymakers seeking to institutionalize community participation frameworks in other urban health contexts.
Delving deeper, the study uncovers how women’s collectives extend their impact beyond immediate health concerns to influence broader social determinants of health. By mobilizing community members to confront issues such as sanitation, nutrition, domestic violence, and education, these groups catalyze systemic changes that ripple through families and neighborhoods. The researchers document instances where collective advocacy led to improved municipal services and heightened accountability from health providers, illustrating the potential of grassroots movements to transcend traditional health sector limitations.
An important technical contribution of the research is its methodological rigor, combining realist synthesis with field observations, in-depth interviews, and participatory workshops. This mixed-methods design not only validates findings through triangulation but also captures the dynamism and evolving nature of community participation. The iterative cycles of data collection and theory refinement exemplify how realist evaluations can inform adaptive management strategies, allowing health programs to be responsive to emerging challenges and community feedback.
Further, the study sheds light on the role of gender dynamics within the health collectives themselves. Women participants often navigate complex social hierarchies that influence their capacity to lead and advocate effectively. The research highlights strategies employed to foster inclusivity and mitigate power imbalances within the groups, such as rotational leadership roles, capacity-building sessions, and mechanisms for conflict resolution. These internal governance structures are shown to be essential for sustaining collective action and enhancing legitimacy in the eyes of both community members and health officials.
In a broader policy context, the findings reinforce the imperative to embed community participation as a cornerstone of urban health strategies, particularly in rapidly urbanizing regions facing multifaceted health challenges. The study argues that investments in women’s health collectives yield dividends not only in improved health indicators but also in strengthened social cohesion and democratic governance. By drawing upon local knowledge and fostering ownership, these participatory models align with international frameworks advocating for equity-oriented and people-centered health systems.
Moreover, the researchers emphasize technology’s emerging role in augmenting the impact of health collectives. Digital platforms facilitate communication, data collection, and monitoring, enabling real-time feedback loops between communities and health authorities. The integration of mobile health applications and social media outreach emerges as a promising avenue for scaling collective efforts while maintaining personalized engagement. Nonetheless, the study cautions against technological determinism, underscoring that digital tools must complement, not replace, in-person trust-building and community rapport.
Importantly, the evaluation delineates a pathway for sustaining these collectives beyond initial project funding cycles. Mechanisms such as linkages with microfinance institutions, partnerships with non-governmental organizations, and recognition through formal policy endorsements contribute to financial and organizational resilience. The sustainability discourse further incorporates considerations of environmental adaptability, ensuring that collectives remain relevant amid shifting urban landscapes and health priorities.
The implications for global health practice are profound. As urbanization accelerates worldwide, vulnerable populations often face compounded health risks compounded by inadequate health infrastructure and social marginalization. The success of women’s health collectives in Chhattisgarh demonstrates a replicable model emphasizing empowerment, equity, and collective agency. It challenges top-down paradigms, advocating instead for co-creation and shared stewardship of health resources as essential for achieving universal health coverage and the Sustainable Development Goals.
In conclusion, this comprehensive realist evaluation not only enriches the academic discourse on community participation and women’s health but also delivers actionable insights for practitioners and policy architects. By elucidating the contextual nuances and causal pathways that underpin collective efficacy, the study offers a blueprint for harnessing community power to transform urban health landscapes. Its findings inspire optimism that health systems embracing participatory approaches will be better equipped to tackle persistent inequalities and foster inclusive, resilient communities.
The transformative potential of women’s health collectives in Chhattisgarh affirms the enduring truth that lasting health improvements are rooted in collective action, empowerment, and equity. As the global health community grapples with evolving challenges, this research underscores the vital role of communities—particularly women—in shaping healthier, more just futures for all.
Subject of Research: Community participation through women’s health collectives promoted by India’s National Urban Health Mission in Chhattisgarh state.
Article Title: Community participation through women’s health collectives promoted by India’s National Urban Health Mission: a realist evaluation in Chhattisgarh state.
Article References:
Abhishek, S., Garg, S., Dewangan, M. et al. Community participation through women’s health collectives promoted by India’s National Urban Health Mission: a realist evaluation in Chhattisgarh state. Int J Equity Health 24, 132 (2025). https://doi.org/10.1186/s12939-025-02498-z
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