Implementing public health projects and interventions across diverse geographies can be challenging. Public health work demands close engagement with multiple stakeholders, from government officials to community members, each requiring different approaches. What appears straightforward in policies or project proposals often becomes far more complex on the ground. In these varied contexts, support from an effective local facilitator, especially for community engagement, is crucial and an ethical imperative in public health.

Experiences with local facilitators in diverse settings

During the early phase of a clinical trial on almond consumption and its effects on glycaemic control and gut health in Kolar district, Karnataka, the first author encountered an unexpected challenge in recruiting participants. After screening seven participants in one camp, he still needed to recruit 20 more. Although the initial participants knew him, they lacked the power, capacity, or resources to mobilise others. During interactions, he identified a young librarian who regularly assisted the community with government documentation. Though he seemed rough at first, this was understood as a cultural nuance, and his local insight earned the first author’s trust. The local facilitator suggested early-morning and late-evening screenings, which aligned with people’s routines. His presence built confidence, and people participated willingly. The collaboration succeeded because it was rooted in respect, valuing humility and courtesy over material benefits, showing how such relationships bridge gaps when research projects are mainly shaped by external expectations.

The first author’s other experience in a clinical trial project in Bengaluru Rural district brought a different challenge. The local facilitator was an ASHA worker who was overburdened, underpaid, and managing multiple responsibilities. Securing her time required patience. This highlighted how community trials designed far from lived realities can overlook the workload of frontline workers unless consciously adapted. The first author supported her with routine tasks, gradually building trust. With her involvement, villagers participated enthusiastically. Although a small incentive compensated her time, her commitment came from genuine dedication, not financial motivation. Her role reinforced the importance of local facilitators in bridging community connections.

When the authors began working on a health governance project with Adivasi communities in Chamarajanagar district, Karnataka, it offered yet another perspective. The project employed a participatory action research (PAR) methodology, which required collective participation. Given the author’s institute’s long-term partnership with the community through a community-based organisation, identifying local facilitators was not difficult. The authors collaborated with local Adivasi leaders and members at two subdistricts in Chamarajanagar district. At one site (site A), the two local facilitators were highly enthusiastic. Their time was compensated, but their commitment went far beyond financial incentives. With their engagement, the community’s recognition of the intention and scope of the research project grew quickly. Their inputs kept the approach rooted in local priorities and helped navigate power dynamics to work meaningfully with community collectives. In contrast, the other project site B proved far more daunting. Local power dynamics in the community collectives emerged as the primary barrier. Facilitators hesitated to engage without explicit approval from their community leaders. Their restricted interest may have stemmed from multiple factors: weak collectivisation of communities, possible vested interests, project resource constraints to meet all the expectations of the community, and the authors’ institute’s limited presence in the area. Even when one facilitator aligned to support the initiative, resistance from other community leaders surfaced, revealing the depth of local politics.

Mechanisms at play

Local facilitators might play an important role because of:

• Their deep familiarity with local cultural and social contexts
• Fair compensation and recognition for their time and labour
• The trust they have built over the years with communities
• Alignment of project goals with their values and priorities
• Perceived respect for their intellectual contributions and lived expertise

However, in some contexts, barriers such as weak community collectives, local power dynamics can affect the engagement of local facilitators.

Key takeaways

Reflecting on these experiences, it becomes clear that meaningful community engagement is neither quick nor linear. It requires patience, sensitivity to local political dynamics, and genuine respect for local facilitators. Entering unfamiliar geographies can leave public health practitioners feeling uncertain, but when approached with humility and a willingness to listen, working with local facilitators turns discomfort into opportunities for learning. Local facilitators are far more than intermediaries; they are essential partners who help navigate social realities, build trust, and implement public health initiatives in ethical and contextually grounded ways. Engaging them is not merely practical but an ethical commitment that affirms respect, justice, accountability, and challenges power imbalances by recognising communities as equal partners.

Authors: Dr Suman V is a public health professional with experience in community engagement and implementation research across diverse public health contexts. (LinkedIn)

Dr. Meena Putturaj, Assistant Professor, DBT/Wellcome Trust India Alliance Fellow, is a health policy and system researcher with a deep interest in the areas of health governance, health care rights and social justice(LinkedIn)

*Both authors work at the Institute of Public Health, Bengaluru, Karnataka, India

 Acknowledgements

The time spent developing this blog was supported by the DBT/Wellcome Trust India Alliance Early Career Fellowship awarded to Dr Meena Putturaj, Institute of Public Health, Bengaluru. Grant ID IA/CPHE/22/1/506530. We thank Zilla Budakattu Girijana Abhivrudhi Sangha and Taluk Soliga Abhivrudhi Sanghas, Chamarajanagar district for their partnership and support.

Competing interest: None

Handling Editor: Neha Faruqui