PATANG: Promoting Community Action for Health - A Co-Produced, Technology-Enabled Platform to Achieve National Goals

Background

In the pursuit of Universal Health Coverage (UHC), Community Action for Health (CAH) is considered a crucial strategy. CAH empowers communities to define their healthcare priorities and monitor the effectiveness of implemented reforms. With a long history in India, CAH has been incorporated into national policies like the National Rural Health Mission and the National Health Policy. Globally, CAH is associated with improved health outcomes, increased health literacy, and stronger healthcare systems. However, despite its potential, CAH faces challenges in India. While a pilot program showed positive impacts, concerns about its confrontational nature led to a shift towards less confrontational methods. Currently, CAH is considered underutilized and under-researched.

A 2020 review called for more systematic and nuanced documentation of CAH experiences, urging the need to identify contexts that enable or hinder its success, as well as scalable and adaptable tools. Current research is fragmented, focusing on individual states or specific efforts without addressing the broader range of CAH approaches. There is a clear need for flexible resources, iterative adaptations, and mechanisms for engaging communities in health service monitoring. This gap in knowledge and documentation underscores the need for further research and action, which the PATANG project aims to address by synthesizing evidence, co-creating a learning platform, and assessing its impact on CAH.

Aim

• To synthesise evidence on the context, mechanisms, outcomes, and costs of CAH best practices in India.
• To co-produce PATANG, a learning platform for civil society and government actors to share CAH lessons, enhance networks and access tools.
• To assess PATANG from the perspectives of civil society, state and community actors in India.

Research Methodology

The PATANG project will be conducted over five years (March 2024 – February 2029) in multiple Indian states—Tamil Nadu, Maharashtra, Chhattisgarh, Jharkhand, and Nagaland—using a mixed-methods, realist-informed, co-production approach. The study will begin with a realist synthesis of existing literature and critical discourse analysis to understand the context, mechanisms, and outcomes of Community Action for Health (CAH) initiatives. Key informant interviews with state and civil society actors will further inform these analyses by exploring the effectiveness of CAH interventions across the states.

The co-production of the PATANG platform will be a key intervention, developed in Year 2. The platform will provide multilingual resources, online and offline tools, and facilitate workshops to support knowledge-sharing among community and state actors. This will help enhance local health planning and improve engagement between communities and health systems. Witness seminars will be conducted with civil society and government actors to further refine the program theories and gain deeper insights into CAH mechanisms.

By Year 4, the impact of the PATANG platform will be assessed through surveys and focus group discussions (FGDs) across exposed and unexposed regions in three states—Tamil Nadu, Jharkhand and Nagaland. The study will use an interrupted time series quasi-experimental design to measure outcomes related to health literacy, service utilisation, empowerment, and engagement between communities and health systems.

The final phase will focus on data analysis, including cost evaluations, and dissemination of findings. These will provide insights into how the PATANG platform can be scaled and adapted to strengthen CAH practices and improve health system responsiveness in different contexts across India.

Current Status

In the current year, under Aim 1, the team has worked with five state collaborators to support the synthesis of evidence on Community Action for Health (CAH) exemplars. They completed a realist review, screening 3,833 records, of which 94 articles were included. Data extraction and quality appraisal have been completed, and the development of the Intervention-Context-Actor-Mechanism-Outcome (ICAMO) framework is underway.

The team has also undertaken a Critical Discourse Analysis (CDA), resulting in a shortlist of 137 national-level policy and guideline documents. The analysis has been completed, and a manuscript has been submitted to Social Science & Medicine -- Health Systems. Key informant interviews (KIIs) have been completed in two states and are underway in three others, yielding a total of 85 KIIs across all study sites: Tamil Nadu (N=11), Nagaland (N=5), Jharkhand (N=8), Chhattisgarh (N=40), and Maharashtra (N=21).

Under Aim 2, through a series of meetings with state collaborators, the team has advanced the PATANG learning platform for civil society actors, government representatives, and community members. The team has consulted with state collaborators, mapped resources, and developed a tagging logic and multimedia content inventory. Team members participated in the 2025 District Health Assemblies (DHAs) and related meetings in Tamil Nadu, contributing to shared learning and the generation of knowledge outputs. A PATANG-affiliated government official from Nagaland served as a panellist at a public event held on UHC Day 2025.

A major cross-project convening was held in March 2026, during which an Aim 2 co-production workshop identified activities for revival, redesign, and strengthening across communities, civil society organisations (CSOs), and state actors. The team has prioritised these activities and proposes structured training programmes, issue-tracking mechanisms for DHAs, and capacity strengthening in Participatory Learning and Action (PLA) through de novo multimedia documentation and website development. The team is also planning cross-learning and exchange events to facilitate collaboration among partners.

The PATANG team organised two first-of-their-kind workshops on Coincidence Analysis (CNA), one at the International Health Economics Association (IHEA) conference in Indonesia and another at IIT Madras.

Through lectures, model-building sessions, and hands-on exercises, participants were introduced to CNA, resulting in the establishment of a community of practice that is now collaborating on a multi-stakeholder grant application for the May 2026 funding window.

Under Aim 3, baseline household survey activities in Nagaland and Tamil Nadu are underway. Partners in Jharkhand have agreed to postpone survey activities due to administrative delays; consequently, collaboration with this partner is currently focused on Aims 1 and 2.

In Nagaland, the baseline survey was completed in May 2026. Initially, Mon was selected as the intervention district. However, this approach was revised so that interventions will be implemented in selected villages, matched 1:1 within both Tuensang and Mon districts. Similarly, in Tamil Nadu, Karur and Dharmapuri have been selected, with intervention and control areas identified within each district to align with partner preferences. Training for field investigators commenced in May 2026, and survey implementation is scheduled to follow immediately thereafter.