"All my co-workers are good people, but…": Collaboration dynamics between frontline workers in rural Uttar Pradesh, India.

Multi-sectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India's Integrated Child Development Services (ICDS) scheme, which serves over 100 million people annually across more than one million villages, a key point of multi-sectoral collaboration - or "convergence", as it is often called in India - is between the three frontline worker cadres jointly responsible for delivering essential maternal and child health and nutritional services throughout the country: the Accredited Social Health Activist (ASHA), Anganwadi worker (AWW), and auxiliary nurse midwife (ANM), or "AAA" workers. Despite the long-recognized importance of collaboration within this triad, there has been relatively little documentation of what this looks like in practice and what is needed in order to improve it. Informed by a conceptual framework of collaborative governance, this study applies inductive thematic analysis of in-depth interviews with 18 AAA workers and 6 medical officers from six villages across three administrative blocks in Hardoi district of Uttar Pradesh state to identifiy key elements of collaboration. These are grouped into three broad categories: organizational (including interdependence, role clarity, guidance/support, and resource availability); relational (interpersonal, conflict resolution); and personal (flexibility, diligence, locus of control). These findings underscore the importance of personal and relational collaboration features, which are underemphasized in India's ICDS, the largest of its kind globally, and in the multi-sectoral collaboration literature more broadly - both of which place greater emphasis on organizational aspects of collaboration. These findings are largely consistent with prior studies, but are notably different in that they highlight the importance of flexibility, locus of control, and conflict resolution in collaborative relationships, all of which relate to one's ability to adapt to unexpected obstacles and find mutually workable solutions with colleagues. From a policy perspective, supporting these key element of collaboration may involve giving frontline workers more autonomy in how they get the work done, which may in some cases be impeded by additional training to reinforce worker role delineation, closer monitoring, or other top-down efforts to push greater convergence. Given the essential role that frontline workers play in multi-sectoral initiatives in India and around the world, there is a clear need for policymakers and managers to understand the elements affecting collaboration between these workers when designing and implementing programs.