title: Analysing implementer narratives on addressing health inequity through convergent action on the social determinants of health in India.
abstract: BACKGROUND
  Understanding health inequity in India is a challenge, given the complexity that characterise the lives of its residents. Interpreting constructive action to address health inequity in the country is rare, though much exhorted by the global research community. We critically analysed operational understandings of inequity embedded in convergent actions to address health-related inequalities by stakeholders in varying contexts within the country.
  
  
  METHODS
  Two implementer groups were purposively chosen to reflect on their experiences addressing inequalities in health (and its determinants) in the public sector working in rural areas and in the private non-profit sector working in urban areas. A representing co-author from each group developed narratives around how they operationally defined, monitored, and addressed health inequality in their work. These narratives were content analysed by two other co-authors to draw out common and disparate themes characterising each action context, operational definitions, shifts and changes in strategies and definitions, and outcomes (both intended and unintended). Findings were reviewed by all authors to develop case studies.
  
  
  RESULTS
  We theorised that action to address health inequality converges around a unifying theme or pivot, and developed a heuristic that describes the features of this convergence. In one case, the convergence was a single decision-making platform for deliberation around myriad village development issues, while in the other, convergence brought together communities, legal, police, and health system action around one salient health issue. One case emphasized demand generation, the other was focussed on improving quality and supply of services. In both cases, the operationalization of equity broke beyond a biomedical or clinical focus. Dearth of data meant that implementers exercised various strategies to gather it, and to develop interventions - always around a core issue or population.
  
  
  CONCLUSIONS
  This exercise demonstrated the possibility of constructive engagement between implementers and researchers to understand and theorize action on health equity and the social determinants of health. This heuristic developed may be of use not just for further research, but also for on-going appraisal and design of policy and praxis, both sensitive to and reflective of Indian concerns and understandings.
authors.affiliation: Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, National Capital Region, 122002, India. devaki.nambiar@gmail.com.
authors.forename: Devaki
authors.initials: D
authors.lastname: Nambiar
authors.affiliation: Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, National Capital Region, 122002, India.
authors.forename: Arundati
authors.initials: A
authors.lastname: Muralidharan
authors.affiliation: Chhattisgarh State Health Resource Centre, Raipur, Chhattisgarh, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Garg
authors.affiliation: The Prevention of Violence Against Women and Children Programme, Society for Nutrition, Education, and Health Action (SNEHA), Mumbai, India.
authors.forename: Nayreen
authors.initials: N
authors.lastname: Daruwalla
authors.affiliation: Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, National Capital Region, 122002, India.
authors.forename: Prathibha
authors.initials: P
authors.lastname: Ganesan
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007194:India; D008297:Male; D017149:Private Sector / Q000639:trends*; D017150:Public Sector / Q000639:trends*; D012111:Residence Characteristics; D064890:Social Determinants of Health