RAHAT- Smart Village Initiative: Addressing inequities and improving access to quality primary healthcare in rural India by harnessing integrated digital health solutions.

The "Smart Village Initiative" project, is designed to address the healthcare challenges faced by the rural population in India. The driving force behind this initiative is the recognition of the public health challenges posed by the dual burden of disease in rural areas, encompassing pre-transitional diseasesand the growing chronic disease burden along with emerging challenges of environmental pollution, climate change and new/re-emerging infections. High quality research remains the cornerstone for identifying suitable solutions to these priority public health challenges. Additionally, access to timely, affordable, and appropriate health care services remains a critical gap in rural areas.

To tackle these challenges and gaps in health service delivery, the proposal will focus on Building research capacity and a model research infrastructure at the level of linked medical colleges (Multidisciplinary Research Units (MRUs) in government medical colleges and Research Divisions (RDs) at private medical colleges) and Bringing in a paradigm shift in health service delivery, leveraging digital advancements to bridge the gap between knowledge and implementation ( the Know-do gap), ultimately improving population health and wellbeing.

The proposed interventions are aimed at enhancing primary care facilities for both non communicable disease and ante-natal care, implementing digital referral pathways, empowering communities, and building institutional research infrastructure, research capacity, and implementation capabilities, improving environmental resilience of the facilities.

The first year will focus on preparatory activities and an extensive needs assessment at the institutional, facility, and community levels. Training programmes and certification initiatives for healthcare professionals will be integral components in this year, emphasizing the importance of research methods, health system strengthening and implementation science, climate resilience and digital health and co-designing the intervention. The subsequent years will focus on and rolling it out in a vanguard mode in all six study sites. The third and fourth year will focus on extending the initiative to full-scale implementation of interventions, incorporating the successful interventions and, change in interventions based on the lessons learnt from the vanguard phase. Concurrent monitoring, refresher trainings, and data collection are emphasized during this phase. The final year will involve the completion of implementation, project evaluation, and sustainability planning for a replicable model towards scale-up. The evaluation will include pre- and post-implementation population and health facility surveys, RE-AIM assessments, incorporating parameters of PROGRESS-Plus framework[1], ensuring a comprehensive understanding of the project’s likely impact.

Anticipated outcomes will include improved access, reduced health disparities, enhanced health outcomes, and the establishment of a scalable and sustainable rural intervention model. The project envisions benefits beyond its immediate scope, including the creation of robust research platforms for future research, nationwide expansion, and serving as a potential model for other lower middle-income countries facing similar health challenges.