The COVID-19 pandemic has exposed deep problems and inequities in India's health infrastructure, which has suffered from decades of underinvestment. But the pandemic also galvanised a wide range of community participation. Non-governmental organisations (NGOs), volunteers, and health-care workers arranged for the supply of oxygen, helped register people for vaccination, ran vaccination camps, and visited communities and schools to speak about the virus and precautions. Notably, many local women, who trained as accredited social health activists (ASHAs), took part in these efforts. They helped to establish trust in their communities, particularly in relation to vaccination campaigns and creating awareness about COVID-19 control measures.There is long historical precedence to such health activism in India. From the 1930s, around the same time that the movement of social medicine started in Europe and the USA, in India different groups and organisations, including international health agencies, missionaries, freedom fighters, and physicians, participated in training nurses and midwives in local malaria eradication programmes, nutrition and sanitation projects, and in establishing and running hospitals and clinics in rural and urban areas. These were gradually engrafted within the planned model of growth launched by the Indian state after independence in 1947. This was the context for how the movement for social medicine took shape in India. Social medicine developed in Europe and the USA during the 1930s among physicians who sought to connect the epidemiological challenges of the 20th century with contemporary economic and social conditions. This was also the period of labour and suffragette movements and anti-imperial and liberation struggles in Africa, Asia, Europe, and Latin America, all of which embraced public health as an important agenda. Therefore, social medicine in the interwar years became linked to political activism and social reform.After independence, India began its primary health-care projects, much as the Bhore Committee of 1946 had advised. The committee, chaired by Joseph Bhore, a member of the Indian civil service, was established by the colonial government in 1943 to undertake a broad survey into the health conditions and organisations in India and to make recommendations for future developments. This vast undertaking sought to tackle problems of poverty, malnutrition, and sanitation by building and running primary health centres (PHCs), ensuring water supply in rural and urban areas, and addressing inadequate hospital facilities, epidemiological challenges, and curative and preventive health agendas. Given the scale of the undertaking, these agendas were often taken forward by many different organisations, such as Population Research Centres, the Voluntary Health Association of India, the Catholic Hospital Association of India, the Christian Medical Association of India, the Foundation for Research in Community Health, the Gokhale Institute of Policy and Economics, the Demographic Training and Research Centre, and several rural health organisations. Alongside these initiatives, missionaries, community nurses, doctors, and health officials worked in different sectors of public health. In doing so, they redefined and practised the governmental health doctrines as everyday social medicine.However, these multiple origins of social medicine in India have often remained obscured behind the banner of the dominant government schemes, such as family planning. India started its state-sponsored National Programme for Family Planning in 1952, after the third International Conference on Planned Parenthood held in Bombay that year. This was part of a financial investment effort by various actors of the Global North in birth control, human reproduction, and sex education. Ford Foundation consultants and researchers from different US schools of public health invested large sums of money and expertise to launch training programmes for nurses, midwives, and doctors in India. These projects have attracted scholarly attention in histories of global population control and family planning projects. However, the family planning undertakings also emerged from wider and complex projects of demographic studies, rural development, maternal health, community development, and nutrition research in India during the 1950s and 1960s, which were often run by health activists.For example, community nursing, which served diverse purposes in rural and urban settings in postcolonial India, developed alongside the family planning projects. Most urban family planning clinics were located near maternity hospitals so that social workers and community nurses could approach women easily in the dispensaries and hospitals for disseminating information regarding family planning practices. The nurses and midwives worked in the maternity wards in hospitals along with family planning and abortion clinics, spreading awareness about maternal and child health. In rural areas, midwives were recruited and trained within the umbrella of family planning projects. They were given a month's training in investigation methods and interview techniques and 2 weeks of training in local family planning clinics. They then stayed in the villages for nearly a year and practised midwifery and treated minor diseases, seeking to gain the trust of the community. In reality, their activities led to the compilation of medical databases, and they served the general purposes of primary health care. Their records documented the health conditions of these villages, epidemics such as malaria, supply of drinking water, alcohol consumption habits, socioeconomic information, the average childbearing age of women, as well as information on public health, dietary habits, and malnutrition.Rural health became one of the most innovative sites of Indian medical initiatives, involving various community and development programmes. Significantly in India, rural health services developed as an integral part of the multipurpose community and rural development schemes and food and nutrition projects. The Narangwal and the Khanna rural health-care projects, which attracted global attention, show that population control often operated as part of rural primary health-care initiatives that had started in India in the post-independence period. The Narangwal Rural Health Research Centre in three community development blocks of the Ludhiana district in the Punjab was established in 1961 and had similarities with the Khanna project of 1952 and rural health projects in other countries during the mid-20th century, such as in Danfa, Ghana, and Lampang, Thailand. Narangwal was a complex operation that established some of the basic modes of community participation in rural primary health care in India. The centre had its primary health clinics run by the Christian Medical College of Ludhiana. The medical team and the resident social scientists also undertook surveys on diet, nutrition, and child and maternal health. Crucially, the project also trained and employed nurses, midwives, and other community health workers. The family health workers, who were mostly women, had previous training as auxiliary nurse midwives and catered for various primary health concerns of the villages, including assisting in childbirth. Female health workers were provided accommodation and lived within the community. The local panchayats (elected village councils) were involved in the planning and implementation of the project. They donated buildings for the village clinics and collected wheat from local farmers for the project's nutrition programme. These were the modes through which nutrition studies and maternal, child, and rural health care became integrated. After the Narangwal project was terminated prematurely in 1974 for various reasons, including the wider context of deteriorating political relations between India and the USA, several members served in other publicly funded PHCs in India. Often seen only as a population control project, it helped to establish the tradition of primary health care in India involving the community, health workers, and medical schools. There were similar units in other parts of the country, including in Najafgarh near Delhi and Naujhil in Uttar Pradesh.Another experimental project in rural health was the Singur Rural Health Unit and Training Centre, which was set up as the Maternity and Child Welfare Unit in 1939 and located in Singur, north of Kolkata in Bengal. In 1944–45, it became the rural health unit of the All India Institute of Hygiene and Public Health. The unit sought to link concerns about rural health with medical education. The medical students and faculty conducted detailed studies of sanitary conditions, housing, hospital facilities, levels of literacy, the health status of children, and problems of addiction, along with providing primary health care. It also became the site of applying the results of medical knowledge to the requirements of the rural population. The Singur Rural Health Unit and Training Centre continues to provide primary health care to 64 villages.Although the general narrative of the PHCs has been defined by the role of WHO and the Alma Ata Declaration of 1978 in the Global South, there were PHC projects that had more diffused origins. From the 1950s, rural health units in India adopted holistic projects that combined rural health with research in agricultural improvements, technical education, and housing and village planning. Village dispensaries and other innovative initiatives run as voluntary or cooperative organisations or as NGOs, such as the people's polyclinic at Nellore in Tamil Nadu or the integrated rural health projects at Jamkhed and Pachod in Maharashtra, provided sustained and often popular health-care options for rural populations.In India and other parts of the Global South, social medicine historically involved large-scale community participation in a tradition that continues today. The future of social medicine in many places in the Global South possibly depends on such activities. However, health activists are increasingly rendered marginal under neoliberal economic regimes and rhetoric dominated by privatised health care with heavy investment in major hospital complexes in urban centres. Health activism cannot by itself compensate for inadequate state investment in health care, but it can be a foundation for future investment by the state in public health. By acknowledging and decently remunerating the activism and vitality of these groups that have historically redefined the social in social medicine in India, it is possible to reinvigorate the voices in favour of greater publicly funded health care with these groups contributing to it.