ToR - Knowledge Deep Dives on Last-Mile Health Delivery Models for Women and Child Health

Across India, governments, civil society organizations and community institutions have developed innovative approaches to improve maternal and child health, nutrition, primary healthcare delivery and last-mile service access. While many of these approaches have demonstrated promising outcomes, their operational models, implementation pathways and contextual learnings often remain fragmented and undocumented, limiting their potential to inform wider programme design, policy dialogue and replication.

SELCO Foundation works across health systems, decentralised renewable energy and community institutions, with a focused emphasis on maternal and child health.

Women and child health outcomes in India remain closely tied to the strength of last-mile service delivery infrastructure, particularly in underserved and rural geographies. Within this landscape lie Anganwadis, Health and Wellness Centres, Primary Health Centres, community health workers, mobile health services, telemedicine platforms, nutrition rehabilitation centres, referral systems, and other community-based initiatives that bridge the gap between households and the formal health system.

While each of these components plays a distinct role, their effectiveness ultimately depends on how well they work together to deliver preventive, promotive, curative, and referral services that are accessible, responsive, and contextually relevant. Yet, significant disparities persist across geographies due to challenges such as inadequate infrastructure, workforce shortages, fragmented service delivery, limited coordination between departments, and difficult socio-economic and geographic conditions. These challenges are particularly pronounced in rural, tribal, and other underserved areas, where women and children often face the greatest barriers to accessing timely care.

Despite these systemic challenges, there are numerous examples across India where governments, civil society organisations, social enterprises, and community institutions have developed innovative and effective approaches to strengthening last-mile health delivery. These "bright spots" demonstrate how different models centred on community health workers, digital health, integrated service delivery, strengthened Anganwadis, mobile outreach, or innovative referral systems, have successfully addressed local challenges while improving access, quality, and continuity of care.

Many of these approaches, however, remain documented only as individual projects or success stories, with limited analysis of the operational models, institutional arrangements, implementation processes, and enabling conditions that underpin their success. There is an opportunity to move beyond documenting what worked to understanding how, why, and under what conditions these models can be adapted or replicated elsewhere, which can create a coordinated, continuum of care pathway.

This assignment seeks to identify, analyse and document selected solution models to distil actionable implementation insights that can inform programme design, policy dialogue, ecosystem learning and replication. In doing so, it will build a structured repository of best practices in