This paper employs the policy capacity framework to develop a multidimensional and nested policy analysis that is able to examine how different types of capacity—analytical, organizational, and political from different related levels of the health system—have contributed to both policy success and failure during the implementation of a politically significant national community health worker (CHW) program in India. Directed toward rural and urban marginalized populations in India, this CHW has become the world’s largest CHW program. Launched in 2006, it has targeted communitization, strengthening of the primary health-care system, and universal health-care coverage, ultimately receiving an international award in 2022. We argue that, in a context of capacity deficits and tensions between different capacity domains, the individual political capacity has been more critical to policy success and strengthening. The analysis not only clarifies the ways in which the government took some initiatives to build up capacity but also highlights capacity deficits along different competency dimensions. This approach demonstrates the value of understanding and creating awareness concerning complex poor-resource settings and low organizational capacity while concomitantly building up the capacities needed to foster (workforce and leadership) strengthening.

中文翻译：

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印度实施社区卫生工作者计划的关键政策能力因素

本文采用政策能力框架来开发多维和嵌套的政策分析，该分析能够检查来自卫生系统不同相关级别的不同类型的能力（分析能力、组织能力和政治能力）如何促成政策成功和失败在印度实施具有政治意义的国家社区卫生工作者 (CHW) 计划。该 CHW 以印度农村和城市边缘化人口为目标，已成为世界上最大的 CHW 计划。它于 2006 年启动，目标是社区化、加强初级卫生保健系统和全民医疗保健，最终在 2022 年获得国际奖项。我们认为，在能力不足和不同能力领域之间紧张的背景下，个人政治能力对于政策的成功和加强更为关键。该分析不仅阐明了政府采取一些举措来建设能力的方式，而且还强调了不同能力维度上的能力不足。这种方法展示了理解和提高对复杂的资源匮乏环境和组织能力低下的认识的价值，同时同时建立促进（劳动力和领导）加强所需的能力。