Table 1 Summary of drivers of community health programs under expanded framework

Household production of health/SDoH

• Enablers: Redistribution of SdoH [28], modifying SDoH(changing lifestyle, healthy behaviours, care-seeking, self-management) [28, 29], neighbourhood/home clinic model [30], social exclusions, poverty, transportation, housing, and rurality [31].

• Barriers: Illness-focused approach with little attention to health determinants [32].

Services delivery: Facility/community-based health care services

• Enablers: Access to emergency services, affordable and comprehensive health services through a partnership of international humanitarian agencies and local NGOs [33].CHWs provided a lifeline, outbreak understanding communities[34], disease surveillance and rapid health crisis response [35], managing chronic diseases [36], counselling and education, awareness, and navigation of services [37], cost-effective in reaching disadvantaged groups [38,39,40], ward-based teams and FCHVs (promoters, dispensers contact trackers, counsellors, and information disseminators) [6, 41, 42].Health services assistants increased maternity care [42]. Effective services in case of unaffordable private care [43]. Maternity care provider- the effective risk of losing their babies [44]. Reducing low birth weight preterm birth decreased maternal deaths and stillbirths [45, 46]. Implemented comprehensive PHC [47], reduced OOPs in curative care [39], integrated community case management, and consumer empowerment [39, 48]. Multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work [47].

• Barriers: CHWs lacked the skills and funding support to provide NCDs services [49].

Community/facility-based health workforce

• Enablers: CHWs in remote locations in the pandemic, community-based interventions [50, 51], linked community facilities, regular contact with households, community collaborations, and referrals, first-level facility care [50, 52, 53], CHW peer-to-peer education, psychosocial support, and community-based integrated care in collaboration with clinic staff [50, 52,53,54], reach underserved populations and large geographical areas [55, 56], integration of CHWs into care teams to implement diverse public health programs improved performance in the formal system [57, 58], perceived community views, and bridge between the community and facilities to ensure community accountability [59], contextual evidence of connectivity embeddedness, scope work and accountability, ongoing monitoring [60, 61], understanding and implementation of fit-for-purpose [62], performing their duties to cope with the health care and social needs of the specific groups [63], replicable holistic care continuum and patient-centred infrastructure [51, 60, 64]. Access to PHC services in areas within one hour of walking [65], training local volunteers to promote health awareness [66], support completing on-the-job training [54], the retention of village health teams monetary and nonmonetary support (e.g., transportation allowance) [67], transformed care delivery in a complex context [55, 57].

• Barriers: insufficient emergency care, mistreatment, indirect costs, lack of medicines, referral delays, high care costs with low-income families, lack of resources, insufficient training, lack of rapport with communities, difficult geography, lack of sustainability, high workload [6, 40, 41, 56, 58, 62, 68], working conditions and described a lack of respect [67].challenging geography, inadequate resources (infrastructure and equipment), difficult transportation (lack of network), cultural challenges (cultural beliefs and faith), and poor communication (accessibility of ambulance) [35, 40, 51, 68], low demand and poor quality, including emergency services [40].

Community organisations

• Enablers: provided strong community–based health programs for community, local, authority, and community health projects (MATLAB; Deschapellies; Jhamkhet and Gadchiroli) [53], worked with principles (quality, equity, and community vitality and belonging) for comprehensive PHC [69].

Social partnerships

• Enablers: community engagement- co-developing healthcare solutions to various causal factors and enhancing the design and delivery [29, 70]. Strategies to address SDoH towards health equity [31], private sector engaged in integrated community case management [71], community empowerment for disease prevention and health promotion building bottom-up cost-effective PHC-based systems [72], community communication (with trust, honouring partnerships), contributing to the community (capacity building, information sharing), and speaking the same language (hearing and respect) [73], community networking (based on faith and location) for collaborative opportunities to increase capacity, credibility, and confidence [74], sustainable collaboration and cross-sector alignment and reduced disparities towards improved health outcomes [75], community health planning scheme improved geographical access using a system approach working with communities to manage competing priorities [76], adopting a participatory process (e.g., co-design) for screening symptoms for chronic diseases, and establishing referral pathways [36], community ownership and partnerships and engaging internal and external champions generated public demand, social support, and PHC revitalization [35, 38, 66, 77], strengthening the public health system influenced health benefits towards improvement in MCH services [38, 66], community engagement depends on the organisational factors (culture capacity, community consultation, resources, and local government accountability to communities) [59, 61, 78], acceptable and socially connected primary care, inbuilt with social well-being, trust, and learning health system [61, 78], community acceptance and ownership, societal values and norms, and technical and political arguments to find strategies [38, 77].

• Barriers: Lack of funding and human resources, poor communication, limited time, risk aversion and mistrust [74].

Commodities

• Enablers: Private sector engagement in community case management, standardisation of drug shops (e.g., record keeping, licensing), compliance with regulatory requirements [48], use of technologies, perceived efficacy legitimacy and trust in drug shop stakeholders [47], Smart Use of Medicines, a community pharmacy for improving rational and primary care [78], and community health systems need to revitalize logistics management systems [35, 49, 68].

Financing

• Enablers: Motorcycle taxi entrepreneurs got loans [79], resource allocation and funding strengthened community health systems [35, 52], shifting of mid-level health workers decreased the cost of care in clinical practices and presented a viable option for cost savings and efficiency improvements [64, 80], health insurance for the probability of seeking care and reduced delays [28], rural-to-urban migrants linked with insurance programs [81], financial incentives and community performance-based financing in preventing NCDs [49, 56], domestic funding mechanisms overcome bottlenecks of community health programs [35], flexible community-funded integrated care outreach clinics approach increased domestic funding [71, 79], ongoing incentives (motivation, recognition, and remuneration) and ward-based care [41].

• Barriers: Volunteerism costs, a lack of funds for preventive care for NCDs, high and inequitable OOP, fragmentation of public and private systems and poor insurance coverage [38, 49, 52, 60], corruption, poor engagement of informal workers, and poor advocacy for funding and logistical support for the continuation of care [38, 49].

Leadership and governance

• Enablers: Decentralization-governments coordinating between administrative and political functionaries, community health committees, transforming power relations, increasing subnational responsibilities, and citizen participation [82,83,84], operational pathways of decentralization voting with feet, close to the ground, and watching the watchers [83]. Community-controlled governance: important for local health governance in financial planning and management and developing workforces for comprehensive PHC services [78, 85], community health planning scheme in leadership to ensure adequate resources [76]. Community Health Committees govern health programs through meetings, contacting the community, lobbying and arguing with governments for support, and taking control of health care [86].

• Barriers: Little government ownership of CHPs (e.g., low funding, poor coordination, and communication), strong donor influence, contradicting policies, a top-down reform process, and fragmentation of PHC [49, 71, 87]. Failure to address pre-existing negative contextual norms and practices, varied decision-maker values, limited priority-setting capacity, lack of community accountability, and focus on curative care [82]. Lack of convergence between governments’ political and programmatic arms, a clash of values between rule-based administrative and a network-based political culture, and inadequate local capacity-building [84].

Information, learning and accountability

• Enablers: Analysing real-time data and utilization of informed changes and engaged providers [61], information systems for ensuring supply chains (e.g., quantification, procurement and distribution of commodities) [38], evidenced-based health ecosystems in partnership with community [29], primary care with a state-of-the-art information system connecting specialist services, a single enterprise healthcare network [88].Health system and evidence-informed guidelines in policy decision-making [89].

• Barriers: Recruitment and mobilisation, including the role of digital technologies), management, and institutionalization [71, 90].