The Project is being implemented as multi-site research and implementation programme across six medical institutions (Agartala Government Medical College, Agartala; BKL Walawalkar Rural Medical College, Ratnagiri; Christian Medical College, Ludhiana; Madras Medical College, Chennai; PSG Institute of Medical Sciences and Research, Coimbatore; and Yenepoya Medical College, Mangalore) in India and their affiliated Rural Health Training Centres (RHTCs)/ Primary Health Centres (PHCs). It follows a phased approach to ensure that interventions are contextually relevant, informed by evidence and responsive to local health system and community needs.

The execution began with formative phase which focused on understanding existing healthcare system, service delivery gaps and community needs. This phase involved qualitative interviews with faculty, students, researchers, healthcare providers and community members; facility assessments at RHTCs; patient exit interviews; antenatal care (ANC) service assessments; and household-level enumeration and baseline surveys. Existing Medical Research Units (MRUs)/ Research Divisions (RDs) were leveraged to conduct situational analyses for strengthening institutional research processes.

Findings from formative phase informed refinement of implementation strategies, including research capacity-building activities, training frameworks and digital health workflows. Multi-stakeholder meetings and a co-design workshop were also conducted to refine strategies across priority domains such as digital health, maternal health, non-communicable diseases and community engagement.

The project has now transitioned into vanguard phase, during which implementation pathways, roles and workflows have been clarified. This phase focuses on preparing institutions, facilities and communities for iterative implementation and testing of interventions. Collectively, these processes aim to support scalable and sustainable improvements in rural primary healthcare delivery.