Trust, Mobilization, and the Limits of Awareness: Failures in Community Engagement

In Kundapura a coastal district in Karnataka, South India, ageing populations, chronic illness, migration, and household vulnerability compound health vulnerabilities. KHPT envisioned a holistic health model led by Gram Panchayats which are decentralized self-governance bodies positioned to integrate welfare services through local participation. The mission, "Moving from Welfare to Care," aimed to shift from scheme-based, top‑down to bottom‑up, person‑centred care approaches.
A detailed household needs assessment covering 5,721 households revealed that 11.47% of households had members above 65 years, 5.7% were headed by single women, minors, or elderly caregivers, 5.2% belonged to primitive vulnerable tribal groups, and over a quarter (27.4%) experienced seasonal migration. Additionally, 1.3% of households had a cancer patient, and 3.8% had physically or mentally challenged members unable to conduct daily duties. These findings underscored community palliative care (CPC) as an urgent need. 
We formed a cluster of seven Panchayats and a task force that brought together local leaders, health system actors, and community members as a convergent body to imagine and drive the CPC initiative.
Despite strong intent, competing agendas, concentrated leadership, and limited community engagement hindered the model. Needs assessment process was compromised, volunteers were not mobilized, and governance gaps persisted. Funding pressures and lack of early alignment deepened challenges. The model was deemed unsustainable.
These failures highlight that decentralization must be embedded at every stage, with inclusive governance, community involvement, transparency, and aligned resources. For SBCC the lesson is clear: trust, communication, and shared ownership are the foundation of community program models.

In Bamiyan, Afghanistan, CRS aims to enhance the resilience of local communities through improved natural resource management and watershed restoration. This project targeted two valleys and engaged 30 communities, indirectly targeting approximately 15,000 beneficiaries. The project's theory of change focused on promoting natural sharing of promoted practices by influential community members to increase adoption of desired behaviors for example, during community celebrations, participating farmers would share testimonials highlighting the key benefits following the use of new resource management practices.
However, organic sharing was insufficient to meet project goals for beneficiaries reached, so the project opted to identify four lead farmers from each community (30 Female and 90 Male) to provide technical support for the neighboring communities and share testimonials. A key strategy involved providing coaching and guidance to each lead farmer as they prepared to share testimonials by traveling to neighboring valleys.
Challenges arose as local authorities-imposed travel restrictions on organizations. Communities were also skeptical of neighboring farmers viewing them as outsiders. Concerns regarding the perceived competency of lead farmers and the lack of subsidies for communities hindered effective knowledge transfer and acceptance of new practices. Our well-intentioned design aimed to leverage community resources by engaging farmers to promote climate-smart practices. We recognized that the approach had not sufficiently built trust and accountability, nor facilitated collaborative change. Moving forward, it's essential to focus on fostering relationships and creating an environment conducive to collaboration, enabling better support to farmers in adopting sustainable practices that benefit their livelihoods and the environment.

Extant research has long documented the association between domestic violence and homelessness. Yet, there appear to be few interventions to address the housing needs of survivors of domestic violence, and none on a digital platform. Thus, we sought to determine the feasibility of a full-scale intervention trial of a web-based tool that screens and educates survivors of domestic violence on affordable housing programs in New York City; as well as to assess the perceived usability and acceptability of the tool. Partnering with a community-based domestic violence center in New York City, we recruited survivors (participants) into one of two study groups: usual care without (SC) or with the tool (SC+).  Usual care included private meetings with a case manager to discuss housing and other benefits. To deem the study feasible for a full-scale trial, we established two "Go" criteria: 1) a preliminary positive change in at least one of the outcomes (housing knowledge, housing self-efficacy, and staff trust); and 2) an average positive intent to continue using the tool after the study.  Overall, a "Go" outcome was not achieved.  While a positive preliminary change was observed in housing self-efficacy, the participants, on average, did not express an intent to continue using the tool after the study.  Nonetheless, the study provides several recommendations, grounded in community-based participatory research (CBPR) and implementation science approaches, for conducting research with community organizations.