India’s Aspirational District Program: ​​Unpacking public health guidance to strengthen government health systems (IRADAE)

Background

Building healthier communities requires more than hospitals and healthcare services. Factors such as nutrition, education, sanitation, livelihoods, and local governance all influence people's health and well-being. Recognising this, governments and global health organisations are increasingly promoting multisectoral convergence: an approach where different sectors work together to improve health and broader health outcomes.  

The IRADAE project explores how this idea is being put into practice through India's Aspirational District Programme (ADP) and Aspirational Block Programme (ABP). These initiatives aim to improve development outcomes in several of India’s regions that face development challenges by encouraging collaboration across sectors and catalysing greater local leadership. Through this research, we seek to understand what happens when ambitious policies move from paper to practice. How are these ideas interpreted by government officials? How are they implemented at district and community levels? And most importantly, how are they experienced by the people they are meant to benefit? By answering these questions, the project aims to generate lessons that can help strengthen efforts to work across sectors and systems to improve health and development outcomes in India and around the world.  

Aim

This research investigates implementation of “multisectoral convergence," where different sectors work together to improve health outcomes, in India. The research has four main goals:   

1. To examine how public health guidance for multisectoral approaches is created, negotiated, interpreted, and incorporated into government systems.  

2. To understand how health-related policies are adapted and translated as they move from the national level to states, districts, and local communities.  

3. To study how data and monitoring systems are used to measure the success of the Aspirational District Programme, and to identify important issues that may not be captured by existing indicators.  

4. To explore how district governments, local officials, and community members understand and experience the Aspirational District and Aspirational Block programmes.   

Research Methodology 

We are undertaking a multi-sited ethnography of India’s Aspirational District program and Aspirational Block Program, following policy from its formulation at the national level, to its interpretation and translation at the state level, and ultimately at district, block and local, village levels. At the national, state, district and sub-district levels, we are conducting interviews with policymakers, implementers, and intended beneficiaries of the programmes. We are also carrying out participant observation of program implementation.  

We aim to theorise and understand the relationship between individuals, local forms of governance, national structures, and transnational organisations in the formulation and implementation of complex policy. Alongside national-level data collection, the study focuses on Kerala as the selected state for field work. Within Kerala, Aspirational Blocks in Wayanad, Idukki, Kasaragod, and Palakkad districts serve as the specific sites for data collection.    

Current Status

 In the current year, the project is primarily focused on data collection. Key informant interviews with policymakers, implementers, frontline workers, and beneficiaries are ongoing across national, state, district, and sub-district levels. Participant observation is being conducted at the district and sub-district levels, where the study team observes meetings convened by district and block-level actors. Simultaneously, transcription and coding of interview transcripts are underway. Materials for academic outputs and manuscript development will be prepared in collaboration with Johns Hopkins partners after the data collection and analysis phase.