ABSTRACT:
Community participation (CP) is widely promoted in India’s health policies, yet its meaning, operationalisation, and governance effects in urban health systems remain contested. This combined policy and literature review examines how CP is envisaged within urban health governance, particularly in Bengaluru, by tracing policy evolution, mapping participatory platforms, and assessing linkages to rights-based approaches. We reviewed 47 policy documents and 48 research publications using structured extraction focused on definitions, platforms, historical trajectories, policy context, right-to-health dimensions, and strengthening opportunities. Findings show a long policy trajectory, from early calls for participation to institutionalisation through recent reforms. Across policy and literature, CP is widely used but inconsistently interpreted. Policy discourse shows conceptual expansion, CP is increasingly framed as multi-level engagement across planning, implementation, monitoring, and accountability, but still marked by tension between service-delivery and rights-based interpretations. For example, Mahila Aarogya Samitis (urban health committees for women) are positioned as women-led CP platforms with expansive roles but their effectiveness is evaluated through narrow service-output indicators, reinforcing an “extension-of-the-system” logic. Rights-based interpretations remain fragmented: India has not formally adopted the right to health in national policy, and explicit rights language was removed from policies, although CP is sometimes framed as a right-to-health enabler within AAAQ domains. Persistent gaps include vague definitions, inequitable representation (notably exclusion of marginalised groups), weak institutional support (training, funding, supervision), and limited accountability and grievance-redress pathways. Bridging these gaps and strengthening CP in urban health governance will require policy to move beyond assigning tasks to communities and instead specify decision rights, resource commitments, and enforceable accountability pathways, including clearer integration of health participation platforms with urban local bodies and deliberative spaces. In parallel, evaluation metrics that capture decision-making influence, equity, and responsiveness alongside service outputs are needed.