A qualitative evaluation of an integrated health and livelihood development project for marginalized communities in India

Date Icon Publish Date
  • Shantanu Sharma
    Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. https://orcid.org/0000-0002-5064-4782
  • Faiyaz Akhtar
    Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA-Health Institute for Mother and Child, Delhi, India.
  • Rajesh Kumar Singh
    Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA-Health Institute for Mother and Child, Delhi, India.
  • Sunil Mehra
    Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA-Health Institute for Mother and Child, Delhi, India.


Background: A community-based intervention was implemented to improve maternal, child, and adolescent health practices, promote financial literacy and enhance livelihood opportunities for young people in marginalized communities. A hypothesis related to our intervention was that peer-led education sessions on health and nutrition in conjunction with community mobilization would change communities’ perceptions towards maternal and child health.

Design and methods
: This three-year intervention was done in the two districts of Rajasthan, India, namely Nagaur and Pali. The paper explored the changes in perceptions and practices that resulted from this intervention among women and adolescents. We performed a retrospective, qualitative effect evaluation of the project. Focus group discussions with married women (15-49 years) and adolescents (10-19 years), and in-depth interviews with frontline workers and village health committees were done. The qualitative data were translated, coded, and analyzed thematically using an inductive approach.

: Overall, 4853 women and 8158 adolescents were engaged in the intervention. The study seemed to have brought a change in some of the practices like postnatal care uptake, breastfeeding, and uptake of antenatal care among women, and enhanced awareness about sexual and reproductive health and harms of substance abuse among adolescents was noted. Around 23% and 67% of the young people from Nagaur and Pali, respectively, were linked with jobs in computer training centres, tailoring centres, and beauty parlours.

: The intervention was perceived successful in improving many health and nutrition practices and livelihood opportunities among project beneficiaries, calling for a comprehensive and multi-dimensional intervention to target social determinants of health.


Sachs J, Schmidt-Traub G, Kroll C, et al. Sustainable Development Report 2019. Accessed: 5 Oct 2019. Available from: https://github.com/sdsna/2019GlobalIndex/blob/master/country_profiles/India_SDR_2019.pdf

World Health Organization. India has achieved groundbreaking success in reducing maternal mortality. 2018. Accessed: 12 Dec 2019. Available from: https://www.who.int/southeastasia/news/detail/10-06-2018-india-has-achieved-groundbreaking-success-in-reducing-maternal-mortality

World Bank, Government of India, NITI Ayog. Healthy states, Progressive India. Reports on the rank of States and Union Territories. 2018. Accessed: 15 Aug 2019. Available from: https://niti.gov.in/writereaddata/files/Healthy-States-Progressive-India-Report.pdf

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16. 2017. Accessed: 10 Jun 2019. Available from: http://rchiips.org/nfhs/NFHS-4Reports/India.pdf

Jacobs C, Michelo C, Moshabela M. Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups. Implement Sci 2018;13:74. DOI: https://doi.org/10.1186/s13012-018-0766-1

Jennings MC, Pradhan S, Schleiff M, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 2. maternal health findings. J Glob Health 2017;7:010902. DOI: https://doi.org/10.7189/jogh.07.010902

Nyamtema AS, Urassa DP, Van Roosmalen J. Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth 2011;11:30. DOI: https://doi.org/10.1186/1471-2393-11-30

Sharma BB, Jones L, Loxton DJ, et al. Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia. BMC Pregnancy Childbirth 2018;18:327. DOI: https://doi.org/10.1186/s12884-018-1964-1

Sircar NR, Friedman EA. Financial security and public health: how basic income & cash transfers can promote health. Glob Public Health 2018;13:1878-88. DOI: https://doi.org/10.1080/17441692.2018.1460383

Javanparast S, Windle A, Freeman T, Baum F. Community health worker programs to improve healthcare access and equity: are they only relevant to low- and middle-income countries? Int J Health Policy Manag 2018;7:943-54. DOI: https://doi.org/10.15171/ijhpm.2018.53

Mehrotra S, Mehrotra VS. Challenges beyond schooling: Innovative models for youth skills development in India. In: Pavlova M, Lee JK, Maclean R, editors. Transitions to post-school life. Education in the Asia-Pacific Region: Issues, concerns and prospects. Singapore: Springer; 2018. DOI: https://doi.org/10.1007/978-981-10-6476-0_2

Santha SD, Banerjee S, Sasidevan D. Mapping social innovation among youth and adolescents: A situational assessment of livelihood promotion and enhancement initiatives in India. In: Bharat S, Sethi G, editors. Health and Wellbeing of India's Young People. Singapore: Springer; 2019. DOI: https://doi.org/10.1007/978-981-13-6593-5_6

Hatcher AM, Lemus Hufstedler E, Doria K, et al. Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings. Transcult Psychiatry 2020;57:124-39. DOI: https://doi.org/10.1177/1363461519858446

Kassie M, Abro Z, Wossen T, et al. Integrated health interventions for improved livelihoods: A case study in Ethiopia. Sustainability 2020;12:2284. DOI: https://doi.org/10.3390/su12062284

Mehra D, Sarkar A, Sreenath P, Behera J, Mehra S. Effectiveness of a community based intervention to delay early marriage, early pregnancy and improve school retention among adolescents in India. BMC Public Health 2018;18:732. DOI: https://doi.org/10.1186/s12889-018-5586-3

Sogarwal R, Chandra M, Mehra S. Youth friendly health services and role of outreach activities to improve access to services. Open J PrevMed 2013;3:191-8. DOI: https://doi.org/10.4236/ojpm.2013.32026

Government of India. Census 2011. Accessed: 20 Nov 2019. Available from: https://www.census2011.co.in/states.php

Government of India, Finance Commission. SDG India – Index and Dashboard 2019-20. Accessed: 1 Jan 2020. Available from: http://niti.gov.in/sdg-india-index-dashboard-2019-20

Rajasthan human development report 2002. Accessed: 7 Nov 2019. Available from: http://planningcommission.nic.in/plans/stateplan/sdr_pdf/shdr_raj02.pdf

Government of India, Ministry of Women and Child Development. Integrated Child Development Service Scheme. Accessed: 1 Jan 2020. Available from: https://icds-wcd.nic.in/icds.aspx

Ved R, Sheikh K, George AS, Raman VR. Village Health Sanitation and Nutrition Committees: reflections on strengthening community health governance at scale in India. BMJ Glob Health 2018;3:e000681. DOI: https://doi.org/10.1136/bmjgh-2017-000681

Singh R, Purohit B. Limitations in the functioning of village health and sanitation committees in a north western state in India. Int J Med Pub Health 2012;2:39-46. DOI: https://doi.org/10.5530/ijmedph.2.3.9

Sharma R, Webster P, Bhattacharyya S. Factors affecting the performance of community health workers in India: a multi-stakeholder perspective. Glob Health Action 2014;7:25352. DOI: https://doi.org/10.3402/gha.v7.25352

Mozumdar A, Khan ME, Mondal SK, Mohanan PS. Increasing knowledge of home based maternal and newborn care using self-help groups: Evidence from rural Uttar Pradesh, India. Sex Reprod Healthc 2018;18:1-9. DOI: https://doi.org/10.1016/j.srhc.2018.08.003

Lyngdoh T, Neogi SB, Ahmad D, et al. Intensity of contact with frontline workers and its influence on maternal and newborn health behaviors: cross-sectional survey in rural Uttar Pradesh, India. J Health Popul Nutr 2018;37:2. DOI: https://doi.org/10.1186/s41043-017-0129-6

George AS, Mohan D, Gupta J, et al. Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India. Int J Equity Health 2018;17:125. DOI: https://doi.org/10.1186/s12939-018-0838-5

Saggurti N, Porwal A, Atmavilas Y, et al. Effect of behavioral change intervention around new-born care practices among most marginalized women in self-help groups in rural India: analyses of three cross-sectional surveys between 2013 and 2016. J Perinatol 2019;39:990-9. DOI: https://doi.org/10.1038/s41372-019-0358-1

Saggurti N, Atmavilas Y, Porwal A, et al. Effect of health intervention integration within women's self-help groups on collectivization and healthy practices around reproductive, maternal, neonatal and child health in rural India. PLoS One 2018;13:e0202562. DOI: https://doi.org/10.1371/journal.pone.0202562

United Nations Children’s Fund. Ending child marriage: A profile of child marriage in India. 2019. Accessed: 15 Dec 2019. Available from: https://data.unicef.org/wp-content/uploads/2019/02/Child-Marriage_India_for-digital_0215.pdf

Government of India. Pradhan Mantri Kaushal Vikas Yojna (PMKVY). Accessed 18 Dec 2019.http://pmkvyofficial.org/Dashboard.aspx

Raj, M. Pradhan Mantri Kaushal Vikas Vojana: Challenges and opportunities. Int J Acad Res Dev 2018;3:486-9.

Lorthios-Guilledroit A, Richard L, Filiatrault J. Factors associated with the implementation of community-based peer-led health promotion programs: a scoping review. Eval Program Plann 2018;68:19-33. DOI: https://doi.org/10.1016/j.evalprogplan.2018.01.008

Sun WH, Miu HYH, Wong CKH, et al. Assessing participation and effectiveness of the peer-led approach in youth sexual health education: Systematic review and meta-analysis in more developed countries. J Sex Res 2018;55;31-44. DOI: https://doi.org/10.1080/00224499.2016.1247779

Mahat G, Scoloveno MA. Effectiveness of adolescent peer education programs on reducing HIV/STI risk: an integrated review. Res Theory Nurs Pract 2018;32:168-98. DOI: https://doi.org/10.1891/1541-6577.32.2.168

Government of Rajasthan, Department of Rural Development and Panchayati Raj. Rajasthan rural livelihood project. 2010. Accessed: 1 Dec 2019. Available from: http://documents.worldbank.org/curated/en/304151468267326628/pdf/IPP4550REVISED1blic10BOX353791B1pdf.pdf

Our most popular topics on Journal of Public Health Research

Leave a Reply

Your email address will not be published.