A qualitative evaluation of an integrated health and livelihood development project for marginalized communities in 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. Results: 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. Conclusions: 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.