Primary Healthcare Delivery at the Grassroots Level: A Study on the Frontline Workers in the Darjeeling District of West Bengal

Primary healthcare delivery at the grassroots level is fundamental to achieving equitable health outcomes, particularly in geographically challenging regions. This study examines the role of frontline health workers, Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs), in delivering primary healthcare services in the Darjeeling district of West Bengal. The study explores how decentralized health policies are implemented at the sub-center level and how frontline workers navigate everyday constraints in service delivery. Employing a mixed-methods approach, quantitative data from frontline workers are combined with qualitative interviews to capture service coverage, coordination practices, workload, incentive structures, and operational challenges. The findings suggest that decentralization has enhanced community outreach and service accessibility; however, persistent issues, including infrastructure gaps, delayed incentives, role overload, and limited institutional support, continue to affect the effectiveness of service delivery. Frontline workers often rely on adaptive practices to sustain service provision under these constraints. The study contributes to the health systems and primary healthcare literature by providing micro-level evidence from a hilly and under-researched region. It highlights the need for context-sensitive interventions that strengthen frontline support mechanisms to improve primary healthcare outcomes.