{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T04:20:27Z","timestamp":1745986827822,"version":"3.40.4"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nepal Leprosy Trust"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>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\u2019 and health workers\u2019 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: \u2018changes in access to healthcare services\u2019; \u2018changes in health promotion and disease prevention\u2019 and \u2018inequalities and their effects on health\u2019. A fourth theme, \u2018views on the expansion of VAP to non-VAP villages\u2019, 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\u2019s 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.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004458","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T17:35:13Z","timestamp":1745948113000},"page":"e0004458","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the health impacts of implementing a \u2018Comprehensive Rural Health Project\u2019 health system in a low-income region of rural Nepal"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6849-6856","authenticated-orcid":true,"given":"Fred","family":"Barker","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radhakat","family":"Jha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8898-6713","authenticated-orcid":true,"given":"Jasmine","family":"Morrish","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1536-832X","authenticated-orcid":true,"given":"Arbind","family":"Sah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramesh","family":"Choudhary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard W.","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Lavender","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"pgph.0004458.ref001","first-page":"1","volume-title":"Political declaration of the high-level meeting on universal health coverage","author":"United Nations","year":"2019"},{"issue":"9642","key":"pgph.0004458.ref002","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/S0140-6736(08)61372-0","article-title":"Return to Alma-Ata","volume":"372","author":"M Chan","year":"2008","journal-title":"Lancet"},{"issue":"15","key":"pgph.0004458.ref003","doi-asserted-by":"crossref","first-page":"E463","DOI":"10.1503\/cmaj.170784","article-title":"Why strengthening primary health care is essential to achieving universal health coverage","volume":"190","author":"C van Weel","year":"2018","journal-title":"CMAJ"},{"key":"pgph.0004458.ref004","volume-title":"The contribution of family medicine to improving health systems: a guidebook from the world organization of family doctors","author":"M Kidd","year":"2020"},{"key":"pgph.0004458.ref005","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/1478-4491-9-27","article-title":"Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa","volume":"9","author":"JB Christopher","year":"2011","journal-title":"Hum Resour Health"},{"issue":"5","key":"pgph.0004458.ref006","doi-asserted-by":"crossref","first-page":"699","DOI":"10.2105\/AJPH.2019.304968","article-title":"The Jamkhed Comprehensive Rural Health Project and the Alma-Ata Vision of Primary Health Care","volume":"109","author":"H Perry","year":"2019","journal-title":"Am J Public Health"},{"issue":"10","key":"pgph.0004458.ref007","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1056\/NEJMp1305636","article-title":"Community health workers--a local solution to a global problem","volume":"369","author":"P Singh","year":"2013","journal-title":"N Engl J Med"},{"issue":"1","key":"pgph.0004458.ref008","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12960-016-0163-2","article-title":"The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014","volume":"14","author":"H Schneider","year":"2016","journal-title":"Hum Resour Health"},{"issue":"Suppl 3","key":"pgph.0004458.ref009","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12961-021-00748-4","article-title":"Community health workers at the dawn of a new era: 5. 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