Evaluation of an integrated health and livelihood development program for marginalized communities in India

Abstract

Background: Women from marginalized communities have poorer maternal health outcomes and limited utilization of health services compared to other communities. There is empirical evidence that comprehensively designed interventions targeting health education of women and social determinants of health, such as financial security, have better outcomes than focusing on health education alone. A community-based intervention was implemented to improve maternal, child, and adolescent health practices in marginalized communities. Besides, the project aimed to promote financial literacy and enhance livelihood opportunities for young people. This three-year peer-led intervention was done in the two districts of Rajasthan, namely Nagaur and Pali. The paper aimed at assessing the effectiveness of this community-based intervention. Methods: Pre-post study design based on qualitative research was used for the evaluation of the intervention. Purposive sampling was done both at baseline and the end-line assessments. Focus group discussions were done with women (15-49 years) and adolescents (10-19 years), and in-depth interviews with frontline workers and village health committees were done. Content analysis was done. Results: Overall, 4853 women, and 8158 adolescents were engaged in the intervention in two districts. We found a noticeable change in some of the practices like institutional delivery, breastfeeding, uptake of antenatal care among women, and knowledge about sexual and reproductive health among adolescents. Around 23% and 67% of the young people from Nagaur and Pali, respectively, were linked with jobs in computer training centers, tailoring centers, and beauty parlors. However, we found a lack of change in some of the indicators, such as knowledge about HIV testing during pregnancy, uptake of contraceptives, and iron-folic acid consumption among women. Early marriage was widely prevalent in the districts, the reduction of which was underachieved. In the interviews, frontline workers reported having been impartial and inclusive in delivering health services. Conclusions: We found evidence suggesting that peer-led interventions are equally effective in improving maternal and child health practices and livelihood promotion. The gaps at system-level, coupled with the presence of specific socio-cultural contextual factors might explain for lack of improvement in some of the indicators.