Achieving universal health coverage is re-visualised within the country through the newly designated AB-HWCs. Their role is crucial in delivering 12 expanded comprehensive primary health care (CPHC) services at the community level, driving multiple reforms within the healthcare system to realise its full potential. Continuum of care and protecting people from catastrophic expenditures being the principles, CPHC through AB-HWCs are aligned to the critical elements of expanded service delivery, telehealth/referral, expanding human resources, medicines and developing diagnostics, community mobilisation and health promotion, robust IT systems, infrastructure, partnership for knowledge and implementation, financing/provider payment reforms.

 However, implementing the CPHC services as guided is challenging across various contexts. The challenges include infrastructure issues, low resources (including human resources, drugs, diagnostics and other logistics), willingness to work in some geographical regions, etc. Delivering high-quality CPHC services through AB-HWCs equitably needs strengthening of the AB-HWC services. The strengthening of HWCs can happen by improving the infra-structural facilities and resources, the management practices and the overall work culture in the existing healthcare system. We know that AB-HWC strengthening can happen incrementally. However, there is a need to accelerate the progress towards the programme goals by identifying existing challenges, incorporating the best practices and developing context-specific strategies within the existing resources to make the AB-HWCs fully functional.

 Implementing the CPHC services through AB-HWCs as guided is a significant challenge across various contexts, including districts like Chamarajanagar. This district is relatively new (only two decades old) and has moved from a backward district within the state to an average one by strengthening the incremental health system. Only district-wide comprehensive system-strengthening reforms like the one proposed can address challenges like inequity concerns and resource constraints.

The ambitious initiative of transforming and strengthening the 221 SHCs and 62 PHCs within the district to AB-HWCs requires a detailed study to understand the challenges encountered in ground-level implementation to suggest design modifications and subsequent scaling up as one of the most successful health programmes. This proposed IR seeks to identify, co-develop, and implement appropriate context-specific health service delivery models of the 12 CPHC services through AB-HWCs in partnership with the District Health & Family Welfare Office, Chamarajanagar (DHO). This research can potentially achieve context-specific strategies amenable to scaling up in similar districts and within the state.