The Invisible Work of Maintenance in Community Health: Challenges and Opportunities for Digital Health to Support Frontline Health Workers in Karnataka, South India

Frontline health workers are the first and often the only access point to basic health care services in low-and-middle income countries. However, the work and the issues frontline health workers face are often invisible to the healthcare system, with limited resources to assist them. This study explores the work practices, challenges and roles of frontline health workers in community health with particular focus on pregnancy care in South India. Drawing on the notion of maintenance and articulation work, we describe the maintenance work of frontline health workers maintaining, anticipating, reconciling, and supporting care infrastructures beyond data collection practices. Our findings highlight how socio-cultural practices, perceptions, status, and existing systems influence maintenance work practices. Based on our findings, we suggest moving beyond the focus on training and performance to design CSCW tools to support the maintenance work of frontline health workers as ‘system-builders’ to make healthcare infrastructures work in community health.