Scale-up of community action for health: lessons from a realistic evaluation of the Mitanin program in Chhattisgarh, India

Introduction It has long been argued that health for all is most effectively, democratically, and sustainably facilitated through the presence of community health workers at the grassroots. In India, one the few acknowledged successes in community programs include the Mitanin program of Chhattisgarh designed and maintained at the scale of the entire state of Chhattisgarh. This program served as prototype for creation of the cadre of an accredited social health activist under India’s flagship program, the National Rural Health Mission. Typical evaluations of scaled-up interventions like this one examine the population-level health outcomes, placing less emphasis on why any such programs succeed or fail. To fill this gap of knowledge, we undertook the realist evaluation of Mitanin program. Mitanin refers to a female community health worker.