Community-based research

mirajohri2
May 31
4 min read

Overview

(c) Raah Health & Social Development Foundation

The greatest learning in my career has undoubtedly come through fieldwork, in Guatemala and in India. These experiences have helped me continually to renew my commitment to honesty and integrity in global health. The problems faced by marginalised communities are deep and difficult to solve––they typically reflect structural barriers without simple solutions. Regular contact with the field enables me to contribute as a scientist to locally-led, effective approaches and to bring ground realities into the discourse of global health agencies.

Fieldwork in India

After an extraordinary collaboration in Guatemala, in 2012, I found myself in a ‘backwards district’—an official designation—in the northern Indian state of Uttar Pradesh. I had been referred there by my partners as, under my leadership, our team had just won the Gates Foundation’s Grand Challenges Explorations competition, aimed at strengthening immunisation coverage in underserved populations in low- and middle-income countries. With a success rate of less than 3%, we were one of just 94 winners selected from over 3,000 applications.

While all the other winning projects focused on innovations to strengthen immunisation supply, ours emphasised critical failures at the interface between health systems and communities. We proposed that effective community engagement—driven by an understanding of how factors such as gender, social group, religion, and poverty intersect to create local barriers to access—was essential to reaching those excluded from vaccination. While the grant ended 18 months later, our team continued, gaining in strength and experience.

In November 2020, amidst the global COVID-19 pandemic, our team became Raah Health and Social Development Foundation, an Indian non-profit dedicated to advancing health equity in rural India through community-driven innovation. I helped to co-found the organisation to support the efforts of our field team, which has been dedicated––since our serendipitous meeting in 2012––towards community-led approaches for advancing health equity.

Contributions

In Guatemala, work by our team led to:

Improvements in clinical care at a national hospital;
Adoption of a model to prevent mother-to-child transmission of HIV by the Guatemalan Ministry of Health.

In India, our fieldwork has made numerous contributions:

Pioneering work to elucidate the role of maternal health literacy in shaping child health (immunisation and nutrition).(1, 2) Analyses demonstrated how intersecting factors such as gender, education, and poverty shape women's access to knowledge.
Community-based intervention projects focussing on innovative approaches to demand-generation demonstrate that maternal, paternal and community health literacy can be rapidly changed, strengthening health-enhancing behaviours.(3-5)
Documentation of poor living conditions related to inadequate drinking water in our local area. A head-to-head comparison of the United Nations indicator of clean drinking water with a measure of microbial contamination, challenging the then-prevalent UN Millennium Development Goals clean drinking water indicator. This work was highlighted in The Lancet and reached global policy fora.(6) A new indicator was adopted in the Sustainable Development goals period.
Emergency support during the initial phase of the Covid-19 pandemic. The response network used mobile phone technology to provide Covid-19-related information and on-ground emergency response to assist individuals in need (rural and urban poorer, less literate and vulnerable populations, including informal workers migrating to their villages), through a network of 26 civil society organisations. Our team played a key role, providing expertise in public health, awareness of local context, and triaging calls. We reached 1.5 million people and provided emergency assistance to 6000+ SOS calls in the first 100 days of the pandemic.(7)
Development and testing of a hybrid paper-to-digital solution for frontline health workers, using artificial intelligence (AI)-powered optical character recognition features to automatically capture data from paper forms, avoiding burdensome manual data entry.(8)
Development and testing of a cutting-edge multi-sectoral intervention to benefit zero-dose children and missed communities (ongoing).(9)

Perhaps our most important contribution is to nurture a team that is truly effective in serving communities, diverse and inclusive. Our 30+ field staff are all locally based and our core members have been employed continuously since 2012. We consistently invest in the development of our team members' capacities, focusing on a wide range of skills, including leadership, and the use of mobile phones, tablets, computers, and software, while prioritising gender and social equality. The journey has been immensely challenging and rewarding. It continues.

References

Johri M, Subramanian SV, Sylvestre MP, Dudeja S, Chandra D, Kone GK, et al. Association between maternal health literacy and child vaccination in India: a cross-sectional study. J Epidemiol Community Health. 2015. https://doi.org/10.1136/jech-2014-205436
Johri M, Subramanian SV, Kone GK, Dudeja S, Chandra D, Minoyan N, et al. Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India. J Nutr. 2016;146(7):1402-10. https://doi.org/10.3945/jn.115.226290
Johri M, Chandra D, Kone KG, Sylvestre M-P, Mathur AK, Harper S, et al. Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study. Jmir Mhealth Uhealth. 2020;8(9):e20356. https://doi.org/10.2196/20356
Pérez MC, Singh R, Chandra D, Ridde V, Seth A, Johri M. Development of an mHealth Behavior Change Communication Strategy: A case-study from rural Uttar Pradesh in India. Proceedings of the 3rd ACM SIGCAS Conference on Computing and Sustainable Societies; Ecuador: Association for Computing Machinery; 2020. p. 274–8. https://doi.org/10.1145/3378393.3402505
Pérez MC, Chandra D, Koné G, Singh R, Ridde V, Sylvestre M-P, et al. Implementation fidelity and acceptability of an intervention to improve vaccination uptake and child health in rural India: a mixed methods evaluation of a pilot cluster randomized controlled trial. Implementation Science Communications. 2020;1(1). https://dx.doi.org/10.1186/s43058-020-00077-7
Johri M, Chandra D, Subramanian SV, Sylvestre MP, Pahwa S. MDG 7c for safe drinking water in India: an illusive achievement. Lancet. 2014;383(9926):1379. https://doi.org/10.1016/S0140-6736(14)60673-5
Johri M, Agarwal S, Khullar A, Chandra D, Pratap VS, Seth A, et al. The first 100 days: how has COVID-19 affected poor and vulnerable groups in India? Health Promot Int. 2021;36(6):1716-26. https://doi.org/10.1093/heapro/daab050
Pant D, Talukder D, Seth A, Pant D, Singh R, Dua B, Pandey R, Maruthi S, Johri M, Arora C. Robust OCR Pipeline for Automated Digitization of Mother and Child Protection Cards in India. ACM Journal on Computing and Sustainable Societies. 2023. https://dx.doi.org/10.1145/3608114
A cluster-randomised trial of a multifaceted intervention to promote child vaccination and linkage to social protection schemes https://doi.org/10.1186/ISRCTN15768745