Qualitative codebook.

India’s community health workers (CHWs) have taken on an onerous set of responsibilities for the welfare of their clients across a variety of health domains, including providing modern contraception for family planning, promoting childhood vaccinations, and enhancing pregnant women’s nutritional outcomes. Governments have also added technology to this mix under the assumption that new digital tools can relieve the work burdens. Through interviews with 22 CHWs, this study found that, besides offering health services for the community, CHWs report an expanding workload that includes several government initiatives. While beneficial in some ways, digital technologies have also introduced new administrative burdens for CHWs, who must manage recordkeeping across incompatible systems. Our findings highlight the complexities of using mhealth technology, emphasizing the need for solutions that enhance rather than replace the vital role of CHWs in fostering trust and overcoming barriers to vaccination. While CHWs continue to play a pivotal role in improving vaccine uptake and navigating the complexities of healthcare delivery, their expanding responsibilities and the nuanced challenges of vaccine hesitancy—particularly in urban slum areas—underscore the need for ongoing support and adaptation of technology to effectively bridge the gap between healthcare systems and the communities they serve.