CoChat
Sign Up
Cited by 27Global Health Workforce IssuesGlobal Maternal and Child HealthHealthcare Systems and Reforms

The National Village Health Guide Scheme in India: lessons four decades later for community health worker programs today and tomorrow

Open access
Strodel, Rachel J., Perry, Henry B.·2019·Human Resources for Health
DOI 10.1186/s12960-019-0413-1PMC PMC6819573
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Based in part on the success of India’s early community health worker (CHW) programs, the Government of India launched in 1977 a national CHW scheme—the Village Health Guides (VHGs)—to provide preventive, promotive, and basic curative care to rural populations. Although this program had promising origins in smaller demonstration projects, it failed to deliver the hoped-for impact at scale and was abandoned. Based on extensive evidence and experience, the World Health Organization and the World Health Assembly have strongly endorsed the value of national CHW programs and their integration into national health systems. Surprisingly, given the scale and importance of the VHG program and its pioneering nature as a national CHW program, little has been published describing this experience. This article is the second in a series that focuses on critical issues that face the effectiveness of large-scale CHW programs. Case presentation: Several systemic factors emerge as main contributors to the failure of the VHG Scheme, namely, a lack of support from the formal health sector, an overly hasty implementation of the scheme, and poor communication between the government and health centers about the role of the VHGs. The remuneration structure and the VHG selection process were at the root of the program’s shortcomings at the implementation level. Conclusion: National CHW schemes are an increasingly important tool for achieving universal health coverage and ending maternal and child deaths by 2030. Although the VHG Scheme was initiated over 40 years ago, the lessons described in this case highlight important considerations to help both current and future large-scale CHW programs avoid the same pitfalls.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12960-019-0413-1

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The NMC envisions a medical education system that enhances access to quality, affordable medical education, ensuring a sufficient supply of skilled medical professionals across the country, supporting equitable, universal healthcare.

    “The NMC[3] envisions a medical education system that enhances access to quality, affordable medical education, ensuring a sufficient supply of skilled medical professionals across the country.”

    From Family Adoption Program: An NMC-mandated Initiative (2024) · cites this paper as [3]

    The Historical context section discusses the 1974 Srivastava Committee’s aim to align medical training with India’s needs, not an NMC vision. Our copy does not address the NMC’s aims for affordable medical education or the nationwide supply of medical professionals (searched: NMC, affordable medical education, skilled medical professionals). (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Holistic learning experiences have been recognized by the NMC as a vital component in medical education, and the NMC has advocated community-oriented medical education in the form of FAP.

    “Holistic learning experiences have been recognized by the National Medical Commission (NMC) as a vital component in medical education and as a step in this direction, which has advocated a community-oriented medical education in the form of the Family Adoption Program (FAP).”

    From Family Adoption Program: An NMC-mandated Initiative (2024) · cites this paper as [3]

    The Historical context section discusses a 1974 committee’s aim to align medical training with community needs, but it does not address the National Medical Commission’s position on holistic learning or the Family Adoption Program. Searches for NMC, FAP, and holistic community-oriented medical education found no passage supporting those specific claims. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 27

  1. [1]WHO, UNICEF Declaration of Alma-Ata International Conference on Primary Health Care 1978 Alma-Ata USSR
  2. [2]Perry H Crigler L Lewin S Glenton C LeBan K Hodgins S A new resource for developing and strengthening large-scale community health worker programs Hum Resour Health 2017 15 13 10.1186/s12960-016-0178-8 28183351 PMC5301425 · DOI
  3. [4]Banerji D The people and health service development in India: a brief overview Int J Health Serv 2004 34 123 142 10.2190/9N5U-4NFK-FQDH-J46W 15088677 · DOI
  4. [5]Banerji D Social and cultural foundations of the health Services Systems of India Inquiry 1975 12 70 85 125239
  5. [6]Banerji D Politics of rural health in India Int J Health Serv 2005 35 783 796 10.2190/1G7Y-KVE3-B6YV-ANE9 16320904 · DOI
  6. [8]Jobert B Populism and health policy: the case of community health volunteers in India Soc Sci Med 1985 20 1 25 10.1016/0277-9536(85)90305-3 3975665 · DOI
  7. [9]Maru RM The community health volunteer scheme in India: an evaluation Soc Sci Med 1983 17 1477 1483 10.1016/0277-9536(83)90046-1 6635711 · DOI
  8. [12]Nanda A. Health care at the grassroots: Village Health Guides and community participation in rural Punjab. Social Change. 2002;32:111–133.
  9. [13]Desai PB Frankel S Community health work: India’s experience The Community Health Worker: Effective Programmes for Developing Countries 1992 Oxford Oxford University Press 125 155
  10. [14]Alternative approaches to heatlh care report of a symposium [ https://www.worldcat.org/title/alternative-approaches-to-health-care-report-of-a-symposium/oclc/4382161]. Accessed 17 Sep 2019.
  11. [15]Perry HB, Rohde J. The Jamkhed comprehensive rural health project and the Alma-Ata vision of primary health care. Am J Public Health. 2019;109(5):699–704. PMC6459630 30896989
  12. [17]Bhatia K Community health worker programs in India: a rights-based review Perspect Public Health 2014 134 276 282 10.1177/1757913914543446 25169614 · DOI
  13. [19]Pyle D From project to program: the study of the scaling-up/implementation process of a community-level, integrated health, nutrition, population intervention in Maharashtra (India) PhD thesis 1981 Cambridge Massachusetts Institute of Technology
  14. [21]Berman PA Gwarkin DR Burger SE Community-based health workers: head start or false start towards health for all? Soc Sci Med 1987 25 443 459 10.1016/0277-9536(87)90168-7 3118477 · DOI
  15. [22]Leslie C What caused India’s massive community health worker scheme: a sociology of knowledge Soc Sci Med 1985 21 923 930 10.1016/0277-9536(85)90150-9 4071126 · DOI
  16. [23]Clay RM The health guide scheme—the Mysore district, India: the community’s perspective Med Anthropol 1985 9 49 56 10.1080/01459740.1985.9965917 4079700 · DOI
  17. [24]Patnaik S Acceptability of the Village Heatlh Guides Scheme by the community J Commun Dis 1989 21 46 51 2809140
  18. [27]Bose A Morley D Rohde J Williams G The community health worker scheme: an Indian experiment Pracising health for all 1983 Oxford Oxford University Press 38 48
  19. [28]Aswini Kumar N Health care at the grassroots: Village Health Guides and community participation in rural Punjab Social Change 2002 32 111 133 10.1177/004908570203200406 · DOI · Paper page
  20. [29]Gilson L Walt G Heggenhougen K Owuor-Omondi L Perera M Ross D Salazar L National community health worker programs: how can they be strengthened? J Public Health Policy 1989 10 518 532 10.2307/3342522 2621254 · DOI
  21. [30]Pallas SW Minhas D Perez-Escamilla R Taylor L Curry L Bradley EH Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability? Am J Public Health 2013 103 e74 e82 10.2105/AJPH.2012.301102 PMC3682607 23678926 · DOI
  22. [31]Scott K Beckham SW Gross M Pariyo G Rao KD Cometto G Perry HB What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers Hum Resour Health 2018 16 39 10.1186/s12960-018-0304-x 30115074 PMC6097220 · DOI · Paper page
  23. [34]Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399–421. 24387091
  24. [35]Schneider H Okello D Lehmann U The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014 Hum Resour Health 2016 14 65 10.1186/s12960-016-0163-2 27784298 PMC5081930 · DOI
  25. [37]Chan M Lake A Towards ending preventable child deaths Lancet 2012 379 2119 2120 10.1016/S0140-6736(12)60908-8 22682447 · DOI
  26. [38]WHO guideline on health policy and system support to optimize community health worker programmes [ https://apps.who.int/iris/bitstream/handle/10665/275474/9789241550369-eng.pdf?ua=1]. Accessed 17 Sep 2019. 30431747
  27. [39]Cometto G Ford N Pfaffman-Zambruni J Akl EA Lehmann U McPake B Ballard M Kok M Najafizada M Olaniran A Health policy and system support to optimise community health worker programmes: an abridged WHO guideline Lancet Glob Health 2018 6 e1397 e1404 10.1016/S2214-109X(18)30482-0 30430994 · DOI

Cited by

Sorted by citations

Authors
Strodel, R. J., & Perry, H. B.
Affiliations
  • Yale University (US)
  • Johns Hopkins University (US)
Corresponding author
Perry, Henry B.
ORCID
Venue
Human Resources for Health
Publisher
Springer Science and Business Media LLC
Published
2019-10-28
Volume
17
Issue
1
Pages
76-76
ISSN
1478-4491 (ISSN-L)
DOI
10.1186/s12960-019-0413-1
PMC
PMC6819573
OpenAlex
W2981420097
Cited by
27
References
1
Citations by year
2026: 2 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 11 · 2020: 3
FWCI
5.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Resources for Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Bill and Melinda Gates Foundation (OPP 1197181)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
community health workers, program failure, rural health care, program implementation, universal health coverage, India
MeSH terms
Community Health Workers, Community Health Services, Humans, India, National Health Programs, Rural Population, Program Evaluation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review