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Lookup NU author(s): Dr Fred Barker, Professor Richard Walker, Dr Michael Lavender
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 Barker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Establishing and building grassroots, community-based healthcare systems is a key approach to improving healthcare access sustainably in low-income regions of the world. One prominent early example of this was the Comprehensive Rural Health Project (CRHP), inspiring the framework for subsequent large-scale programs globally. However, many community health projects do not provide the same breadth of services as CRHP, which may have impacts on health outcomes. This qualitative study focused on 12 Dalit villages in rural Nepal following an intervention - known as the Village Alive Project (VAP) - to boost healthcare provision through a CRHP-style health system. Villagers’ and health workers’ impressions of changes in healthcare access were assessed through 42 semi-structured interviews. Thematic analysis was performed using NVIVO by two independent authors; themes were finalized by reaching consensus. Three generated themes were shared by VAP and control villages: ‘changes in access to healthcare services’; ‘changes in health promotion and disease prevention’ and ‘inequalities and their effects on health’ . A fourth theme, ‘views on the expansion of VAP to non-VAP villages’, was generated uniquely for the control group. Lack of health education and sanitation facilities, as well as social stigma, were listed as barriers to health prior to VAP’s establishment; most participants felt these have been largely addressed since the arrival of VAP. Implementing more comprehensive primary healthcare on top of pre-existing community-based healthcare systems is feasible, with encouraging findings from this low-income region of rural Nepal. Participants felt VAP improved understanding of diseases such as leprosy, which may benefit future vertical interventions. Improvements in various aspects of health and healthcare were reported for most or all study themes across intervention-group villages; improvements were also noted in control villages but with more evidence of ongoing barriers to health. Further studies looking at key quantitative outcomes are required to triangulate findings.
Author(s): Barker F, Jha R, Morrish J, Sah A, Choudhary R, Walker RW, Lavender M
Publication type: Article
Publication status: Published
Journal: PLoS Global Public Health
Year: 2025
Volume: 5
Issue: 4
Online publication date: 29/04/2025
Acceptance date: 06/03/2025
Date deposited: 19/05/2025
ISSN (electronic): 2767-3375
Publisher: Public Library of Science
URL: https://doi.org/10.1371/journal.pgph.0004458
DOI: 10.1371/journal.pgph.0004458
Data Access Statement: Due to ethical considerations and in accordance with the informed consent obtained from participants, the full transcript data from this study cannot be shared publicly. The transcripts contain sensitive information, and participant anonymity cannot be fully guaranteed due to identifiable details related to specific communities. Making these data publicly available would be against the conditions agreed upon with participants. However, the coding framework used in the study is shared as supporting information file. Researchers with specific inquiries regarding the data may contact the corresponding author or an independent academic colleague, Dr. Bence C. Baljer (bbaljer.80@gmail.com), who has agreed to assist with data access requests where possible while ensuring compliance with ethical guidelines. [See the article for the full data availability statement.]
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