How state policy constructs community participation: A policy discourse analysis of community action for health in India

Introduction Community Action for Health (CAH) is increasingly recognised as integral to achieving Universal Health Coverage, reflected in Sustainable Development Goals commitments and World Health Assembly resolutions on social participation. India offers a case where CAH has evolved over two decades from community-based monitoring pilots under the National Rural Health Mission into a nationally institutionalised participatory governance architecture. This evolution has been shaped by shifting policy vocabularies that redefine participation, legitimacy, and authority, yet the role of policy discourse in shaping participation remains underexamined. Methods We conducted a policy discourse analysis drawing on Critical Discourse Analysis and Bacchi’s “What’s the Problem Represented to Be?” approach. A purposive sample of 137 national policy documents (2005-2024) was analysed using a structured matrix capturing discursive framings and power vocabularies. Fairclough’s linguistic and genre-based tools were used to examine how CAH mechanisms such as VHSNCs, MAS, PLA cycles, Jan Samvads, JAS, and Health Assemblies were narrated and legitimised. Results Three discursive patterns emerged. Participatory mechanisms expanded from facility level oversight toward governance linked platforms. Naming and genre shifts reframed participation from rights-based monitoring toward collaborative, system embedded action, privileging dialogue and community ownership while narrowing accountability claims. A vocabulary of empowerment and ownership positioned communities as partners, foregrounding managerial coordination over rights-based scrutiny. Conclusion In India, CAH operates not only as a programme but as an order of discourse shaping the meaning and limits of participation. As countries operationalise WHA77.2, safeguards may be needed to protect critique, autonomy, and rights-based accountability alongside collaboration.