Swasthyakarmi Yojana: Maternal, Infant and Child Nutrition

---

---

Project Details

Category: Maternal Health
Project Title: Maternal, Infant and Young Child Nutrition (MIYCN) and Swasthyakarmi Yojana
Department or District: Tribal Area Development Department and SWACH Project, Udaipur
State: Rajasthan
Start Date of the Project: 1st January 2025
Website: https://tad.rajasthan.gov.in

---

Tribe(s) that the Project Covers: The project primarily targets tribal populations residing in the Scheduled Areas of Udaipur, Sirohi, Dungarpur, Banswara, and Pratapgarh districts. It also covers tribal-dominated blocks such as Kishanganj and Shahabad in Baran district.

Keywords: Swasthyakarmi Yojana, MIYCN, Maternal and Child Health, Community Health, UNICEF, SWACH, Tribal Development

The Swasthyakarmi Yojana under the Maternal, Infant and Young Child Nutrition (MIYCN) program represents an innovative, community-based approach aimed at combating malnutrition and poor health among tribal mothers and children. Conceived as a collaborative initiative between the Tribal Area Development Department and SWACH with technical support from UNICEF, the project leverages local tribal women as health workers or “Swasthyakarmis” to address the challenges of accessibility, awareness, and acceptability in tribal health systems.

The Project

This initiative focuses on the critical 1000-day window from the beginning of pregnancy to a child’s second birthday. Recognizing that this period is pivotal for preventing stunting and promoting lifelong health, the program deploys trained village-level health workers to ensure maternal and child nutrition through regular home visits, counselling, referrals, and promotion of improved practices in water, sanitation, hygiene, and diet.

Problems that the Project Intends to Solve

The project addresses poor health indicators among tribal women and children caused by geographical isolation, inadequate access to healthcare, lack of education, entrenched cultural beliefs, and systemic neglect. It also aims to break the intergenerational cycle of malnutrition where undernourished mothers give birth to low birth weight babies, perpetuating chronic underdevelopment.

What was the Need

Conventional institutional models failed to make an impact in tribal areas where women were reluctant or unable to visit healthcare centers. There was a clear need for a model that would take healthcare to the doorsteps of beneficiaries while fostering trust, ownership, and sustainability through community participation.

What Hindered its Introduction

The project initially encountered three major barriers—accessibility due to poor infrastructure, accountability due to lack of leadership and workforce, and acceptability due to deep-seated traditional beliefs. The isolation of tribal villages, coupled with suspicion of outside interventions, limited the reach of government programs. Tribal women were often not allowed to step out or engage with government institutions, posing a significant challenge.

Process Followed for Implementation

The Tribal Area Development Department played the central role in implementation by initiating the collaboration, deploying resources, and creating an enabling administrative framework.

SWACH, a community health NGO, provided on-ground operational support. It coordinated with UNICEF to train Swasthyakarmis and design outreach strategies. The collaboration between SWACH and UNICEF led to the development of tools, registers, and counselling materials to guide frontline workers.

Local tribal women were chosen by their own communities to serve as Swasthyakarmis. They became the primary agents of change, offering culturally resonant support and building trust at the grassroots level.

Solutions Implemented

The project deployed Swasthyakarmis to identify, register, and counsel pregnant and lactating women as well as parents of children under two years of age. These workers facilitated antenatal checkups, nutrition counselling, weight tracking, breastfeeding guidance, and hygiene education. They used government-approved tools and a specially designed “1000-day care register” to monitor and document progress. Village Contact Drives were conducted to spread awareness, while training programs built the capacity of workers at multiple levels.

Details of the Coverage

Initially launched in seven blocks of Udaipur, the program was later scaled up to four additional districts. As of the latest data, the program has reached approximately 4.9 million people, with tribals constituting around 50 percent of the population served.

Innovation and Unique Features

The most distinctive feature of this initiative is its community-driven model. By engaging local women as Swasthyakarmis, the project ensured cultural alignment and deeper community trust. The focus on the 1000-day window aligns with WHO and UNICEF global standards for maternal and child health. This model also promotes sustainability and livelihood by providing meaningful employment to over 1400 tribal women.

• New Approaches: Tech Integration, Capacity Building, Culturally Sensitive Methods
  • The project integrated capacity building through regular training in MIYCN, SBCC, and data documentation. The culturally sensitive strategy of using tribal women as health messengers proved pivotal in overcoming resistance. IEC materials and flipbooks enabled visual, language-accessible communication tailored to the local context.
• Co-creation: How Tribal Knowledge or Leadership Shaped the Solution
  • Tribal communities were actively involved in selecting their own Swasthyakarmis, which helped in co-owning the initiative. This created a bridge between tradition and institutional health services, fostering long-term behavior change.
• Any Adaptations: How the Project Evolved during Implementation
  • The program evolved by expanding geographical coverage and building advanced training modules based on field experience. Over time, Swasthyakarmis grew more confident and capable, gaining acceptance as community health leaders.

Challenges Faced Before Implementation

• There was limited availability of trained personnel, low institutional capacity, and poor baseline data.
• Deep-rooted social norms, lack of awareness, and logistical barriers made community outreach difficult.
• These challenges were addressed through persistent awareness drives, trust-building through local workers, strategic partnerships with UNICEF, and continuous on-site monitoring.

Challenges Faced During Implementation

• Managing a decentralized cadre across five districts posed administrative and coordination challenges.
• Seasonal migration of tribal populations, language diversity, and low literacy rates made consistent engagement difficult.
• Localized training, adaptive materials, and community events helped maintain continuity. Swasthyakarmis were trained to adapt communication styles for various audiences.

Outcomes

• Quantitative
  • As of the reported data, 1427 Swasthyakarmis are operational. A total of 14,773 pregnant women received home-based counselling. About 4,652 births were registered, out of which 3,030 were institutional deliveries. Over 1,279 women completed four antenatal care visits, and exclusive breastfeeding practices increased significantly. The use of iodized salt and take-home rations also improved substantially.
• Qualitative
  • There has been a transformation in community attitudes towards institutional healthcare. Women, once restricted to their homes, are now actively participating in their own health journeys. Swasthyakarmis have emerged as respected figures in their communities, bridging the gap between tradition and modern healthcare.

Monitoring is conducted using standardized registers and periodic reviews by district coordinators. UNICEF’s technical support ensures quality assurance and data-driven decision-making.

Replicability / Scalability / Sustainability

The model supports the objectives of national programs such as POSHAN Abhiyaan and can be easily integrated with state ICDS and NRHM structures.

Cost efficiency is achieved through convergence with existing health and nutrition schemes and the use of community resources.

This model is highly replicable due to its community-driven design. The project’s core principle—“for the people, by the people, and of the people”—makes it adaptable to both tribal and non-tribal rural contexts.

Gallery

---