Section 1.

Concept note overview

Name of partner Saathi Samaj Sevi Sanstha
Response to UNICEF- Unsolicited
✘

Type of concept note issued CFEI concept note

CFEI ID CEF/IND/2024/028 CFEI ID N/A
Year of Hope – Strengthening Maternal and Newborn health through 365-day
Concept note title
approach
Geographical coverage Makdi Block, Kondagaon district, Chhattisgarh, India.
Planned Programme Start: 1st April, 2024 End: 31st December 2025
duration
Contribution from prospective partner INR 10,51,000 (14.6%)
Programme budget
Contribution requested from UNICEF INR 61,15,000 (85.4%)
(cash + Supplies)
Total INR 71,66,000

Section 2. Programme Strategy

2.1 Rationale/Context
Bastar region in Chhattisgarh suffers from triple burden of accessibility issue, Left wing extremism (LWE)
activities and tribal population. As per National Family and Health Survey (NFHS) 5 (2020-2021), the challenges
of malnutrition and anaemia loom large, affecting 50% of children and over 70% of women in Chhattisgarh's
Bastar Division. The situation is exacerbated due to prevalent infectious diseases such as malaria and acute
diarrheal diseases.

Studies indicate that inadequate healthcare utilization during pregnancy and childbirth correlates with adverse
maternal and child health results1. It is evident that timely and sufficient healthcare service delivery through 1000
days approach is crucial for enhancing maternal and child health outcomes. Factors contributing to insufficient
utilization include socio-economic challenges, poverty, limited education, and disparities in healthcare resource
access2. Therefore, our project aims to enhance the existing maternal and child health service delivery by
effectively tracking the mothers and newborn and connecting them to system. This initiative seeks to bolster
access, utilization, and quality of Maternal and Child Health care services.

Background of the intervention- Geography (Kondagaon)

Kondagaon is one of the aspirational districts with a population of 6 lakhs (0.6 M) and divided into five blocks
namely Kondagaon, Makdi, Pharasgaon, Keshkal, and Baderajpur. It is predominantly a tribal inhabited region
with 70 per cent of the tribal population like Gond Tribe, Maria, Muria, Dhruva, Bhatra, Halba Tribe, etc. Health
service delivery is a major challenge in the district because of its rough terrain and high incidence of LWE
activities. The constant fear of unpredictable extremist activities has disrupted the service delivery mechanism
and considerably destroyed the government infrastructure in select panchayats. Even deliveries of basic
government services are a major challenge in some of the blocks of Kondagaon.

In Kondagaon, Makdi is aspirational block with 67 Gram panchayats and 100 villages. Healthcare service
delivery is provided by 1 CHC, 4 PHC and 30 SHCs. Annual delivery load is around 2000 deliveries. The block
relates to the Abujhmad region which has very dense forest cover, rough terrain and highly affected by LWE
activities. It makes part of the block inaccessible and prone to conflict and vulnerability. The project will be
implemented across all 100 villages.

1
UNICEF Under five mortality https://data.unicef.org/topic/child-survival/under-five-mortality/
2
Meidani Z, Moravveji A, Gohari S, Ghaffarian H, Zare S, Vaseghi F, Moosavi GA, Nickfarjam AM, Holl F. Development and Testing Requirements for an
Integrated Maternal and Child Health Information System in Iran: A Design Thinking Case Study. Methods Inf Med. 2022 Dec;61(S 02):e64-e72. doi:
10.1055/a-1860-8618. Epub 2022 May 24. PMID: 35609871; PMCID: PMC9788911.
 Key health and nutrition indicators for Kondagaon (NFHS-5)

1. Women aged 20-24 years married before age 18 years (%) 11.8
2. Mothers who had an antenatal check-up in the first trimester (%) 69.4
3. Mothers who had at least 4 antenatal care visits (%) 64.1
4. Mothers who consumed IFA for 180 days or more when they were pregnant (%) 17.3
5. Institutional births (%) 78.7
6. Mothers who received postnatal care within 2 days of delivery (%) 79.4
7. Children who received postnatal care within 2 days of delivery (%) 77.3
8. Children aged 12-23 months fully vaccinated (%) 70.1
9. Prevalence of diarrhea in the 2 weeks preceding the survey 10.9
10. Prevalence of symptoms of acute respiratory infection (ARI) (%) 4.4
11. Children under age 3 years breastfed within one hour of birth (%) 35.6
12. Children under age 6 months exclusively breastfed (%) 85.3
13. Children under 5 years who are stunted (height-for-age) (%) 37.6
14. Children under 5 years who are wasted (weight-for-height) (%) 22.8
15. Children under 5 years who are underweight (weight-for-age) (%) 42.2
16. Children aged 6-59 months who are anaemic (<11.0 g/dl) (%) 76.6
17. Non-pregnant women aged 15-49 years who are anaemic (<12.0 g/dl) (%) 79.5
18. Pregnant women aged 15-49 years who are anaemic (<11.0 g/dl) (%) 87.6
2.2 Implementation Strategy & Technical Guidance (400 words max)
The "Year of Hope" program strategically addresses the pressing maternal and child health challenges in
community focusing on strengthening existing mechanisms. Aspirational block is selected in line of Govt. of India
aspirational district program. 3

Global Standards and Principles:

The program embraces principles of equity and inclusivity, aligning with global standards outlined in the SDGs.
Its lifecycle approach is subset of 1000 days approach reflecting a commitment to international standards for
comprehensive maternal and child health.

National Policies:
In tandem with national priorities, the program harmonizes with existing policies such as the National Health
Mission (NHM). By leveraging synergies with ongoing projects, the initiative aims to contribute significantly to
national objectives, emphasizing the importance of maternal and child health.

The Problem: The effective service delivery of public health system is dependent on balance between supply
side (system) and demand side (community). The theory of change responds to the problem vulnerable
communities face, especially women and children, due to poor accessibility and ineffective service delivery.

Theory of Change comprehensively describes how and why the desired change/ aim of the project could be
brought about. This would act as a roadmap to bring the desired change. The theory envisages that effective
service delivery can be achieved by addressing the demand side issues (improved health seeking behaviour
through community engagement and participation) and supply side issues (stringent monitoring with defined
programmatic accountability with little administrative push).

Intervention: The proposed intervention strongly believes that there is no need to introduce any new process,
new manpower or any new digital product to achieve the change. The mother and children can get quality
healthcare services at the public health facilities through the existing healthcare and community health workers.
It will result in increased demand for public services and would be pivotal in decreasing the mortality and
morbidity of mother and newborn.

For implementing the 1000 days approach, the cohort can be bigger and operational feasibility can be an issue.

3
https://abp.championsofchange.gov.in/about/
Hence, two major outputs are targeted through the intervention – Institutional delivery and Full immunization.
The intervention will target a pregnant woman from start of 7 th month of pregnancy and follow up till the child
reaches 9 months of age. This year long tracking gives the name “Year of Hope”.

The tracking of beneficiaries would be done through a call centre established at office of implementing partner.
Average number of calls to be done daily depends on the amount of data received. However, minimum 30-50
calls per day are expected from the caller which includes attempts to connect with inaccessible numbers.
Objective is to reach every pregnant woman and facilitate the coordination between service providers and
beneficiaries.

TEAMS: The key strategies applied are

1. Tracking every pregnant woman and child

2. Engaging the beneficiary for existing service delivery platforms at facilities and communities
3. Awareness for the beneficiary and family leading to informed decision making and improved health seeking
behaviour
4. Making the system and services ready for effective service delivery
5. Supportive supervision with review and feedback mechanism embedded in existing system

Key Objectives:
1. To ensure that every pregnant woman is delivered in a safe environment with a healthy outcome
2. To ensure that every child receives appropriate care around birth, post-natal care at home as well as
institutions till he/she achieves full immunization
3. To engage and empower stakeholders for effective service delivery – PRI members, SHG members,
traditional healers etc.
4. To strengthen the capacity of healthcare providers and community health workers.
5. To integrate a comprehensive growth monitoring and early childhood development component for
addressing early growth faltering and cycle of malnutrition in both mother and child.

2.3 Capacity Development: (400 words max)

The proposed intervention will focus on following capacity building activities:
 Six (6) quarterly sensitization workshops for traditional healers on maternal and child health issues
 Six (6) quarterly trainings of PRI members from 67 Gram Panchayats on awareness of MCH and social
welfare schemes
 Six (6) quarterly trainings of 200 SHG members from 100 villages on ensuring health services and
community management on nutrition
 One training of front-line health workers on gender sensitization
 Four (4) batches of one day training of village volunteers on MCH service delivery
 Conduct 21 welfare camps (3 per quarter) at villages with different departments to enroll beneficiaries into
government schemes.

2.4 Other Partners involved: (400 words max)

SAATHI has identified key stakeholders who play integral roles in program implementation, bringing diverse
expertise and support to achieve the outlined objectives. The collaborative approach with stakeholders will be
sought for providing technical and financial support.

Government Health Departments: Collaborative efforts are underway to align the program with existing
government initiatives, ensuring synergy and sustainability. The organization will actively engage with health
department to strengthen and streamline service delivery along with enhanced community outreach. It includes
district administration, district program management unit (NHM) & block level functionaries
Community Based Organizations (CBOs): Engaging with local CBOs is fundamental to the program's
success. The organization collaborates with CBOs to ensure grassroots participation, community mobilization,
and effective implementation of health-related interventions. This partnership strengthens the program's reach
and impact at the community level. Engaging with local CBOs is fundamental to the program's success.

Other stakeholder engagement: Engaging and empowering stakeholders like traditional healers, PRI
Members. Women Self-Help Groups (WSHGs) etc. who are very influential persons of the community.
Empowering them will play an important role to advocate for Social Behaviour Change Communication (SBCC)
practices. By incorporating their influence and credibility, the program aims to create a more inclusive approach
to community health. Self help groups would be doing meetings with families for community engagement and
increased male participation in RMNCHA issues.

This collaborative network of partners ensures a comprehensive and holistic approach to maternal and child
health. By fostering synergies with UNICEF, government health departments, CBOs, and international NGOs,
Saathi aims to maximize the impact of the program and contribute significantly to improving health outcomes in
Chhattisgarh.

2.5 Gender, equity, and sustainability (250 words max)

Describe the practical measures in the programme to address gender, equity and sustainability considerations
and how they are rated based on programme prioritization as “principal”, “Significant”, “Marginal” or “None”.

Gender Rating: None ; Marginal ; Significant ; Principal

Narrative:
The "A Year of Hope" program prioritizes gender considerations as a significant element in its design and
implementation. Recognizing the unique health needs and vulnerabilities of women, the program ensures a
gender-sensitive approach. Key measures include targeted interventions for maternal health, promoting
women's involvement in decision-making processes, and addressing cultural factors influencing healthcare-
seeking behavior. The program actively engages with women as direct beneficiaries and empowers them
through education and awareness campaigns.

Promoting Women's Empowerment:

The organization focuses on encouraging women's participation in decision-making processes related to their
health and of their children that can empower them to make informed choices and advocate for their needs.

Equity Rating: None ; Marginal ; Significant ; Principal

Narrative:
Equity is considered a significant factor in the program, aiming to address disparities in healthcare access and
outcomes. By selecting the aspirational block, the organization emphasizes reaching marginalized and
underserved communities, ensuring that the benefits of the program are inclusive and accessible to all. By
collaborating with community-based organizations and engaging with local stakeholders, the program strives to
reduce health inequities and promote a more equitable distribution of resources and services. For addressing
socio-economic hurdles, beneficiaries will be connected to government schemes for financial assistance and
other necessities.

Sustainability Rating: None ; Marginal ; Significant ; Principal

Narrative:
Sustainability is a significant consideration in the program's design and implementation. The organization
strongly believes that effective service delivery can be achieved by addressing the demand side issues
(improved health seeking behaviour through community engagement and participation) and supply side issues
(stringent monitoring with defined programmatic accountability with little administrative push).
The organization focuses on building local capacity, both in terms of human resources and healthcare
infrastructure, to ensure the longevity of positive health outcomes. The program integrates training sessions for
healthcare providers and community health workers, fostering a self-reliant community that can continue
promoting maternal and child health practices beyond the program period. Additionally, the engagement of local
stakeholders and the alignment with government health initiatives contribute to the sustainability of the
program's impact.

Regular monitoring and evaluation of the program's impact on gender equality, equity, and sustainability can
help identify areas for improvement and ensure that interventions are effectively addressing the needs of
women and children. By incorporating these practical measures into the program, it can promote gender
equality, equity, and sustainability while improving maternal and child health outcomes.
2.6 Risk management (250 words max)
Social & Environment:
Risk: Social unrests, insurgencies, and geographical barriers.
Mitigation measures: Working closely with the government and community such unforeseen challenges would
be addressed by the project. Also, implementing innovative methods to curb geographical challenges.

Financial:
Risk: Budgetary constraints impacting program activities.
Mitigation measures: Regular financial monitoring and reporting, effective budget allocation, and ongoing
communication with donors for potential supplementary funding.

Operational:
Risk: Disruptions due to natural disasters or unforeseen events. Also, inadequate understanding of community
needs, infrastructure, or logistics could disrupt program activities.
Mitigation measures: Develop an emergency response plan. Establish partnerships with local authorities for
swift coordination in case of emergencies. Mock drills and training sessions for staff on emergency protocols.
Perform operational assessments to pinpoint potential bottlenecks and vulnerabilities. Implement rigorous project
management practices to optimize operational efficiency.

Organizational:
Risk: Staff turnover and shortages affecting program continuity.
Mitigation measures: Implement a comprehensive HR management strategy, including staff training,
professional development, and recruitment planning. Cross-training of personnel to ensure the availability of
skilled staff.

Political:
Risk: Changes in political climate impacting program support.
Mitigation measures: Establish strong relationships with community and social leaders and government
stakeholders to ensure program alignment with national health priorities to garner ongoing political support.

Strategic:
Risk: Shifts in program strategy impacting effectiveness.
Mitigation measures: Regular strategic reviews and adjustments based on M&E outcomes. Ongoing
collaboration with partners for shared insights and adaptability to changing circumstances.

Safety & Security:

Risk: Threats to the safety and security of program staff, beneficiaries, or assets could disrupt program activities
or endanger lives.
Mitigation measures: Putting strong safety measures in place, like emergency plans and collaboration with local
leaders and authorities to ensure the safety of all.

These identified risks and corresponding mitigation measures are integral components of the program's risk
management strategy. By proactively addressing potential challenges across various dimensions, the program
aims to ensure a resilient and adaptive approach to implementation, safeguarding the achievement of its
objectives.
2.7 Partner non-financial contribution
SAATHI brings substantial non-financial contributions to the "Year of Hope" program, enhancing its overall
impact and effectiveness by providing management contributions by the other experts and managerial staff
contribution outside the program budget.

Technical expertise: The organization leverages its experience in community mobilization, behaviour change
interventions, and healthcare initiatives in rural areas of Chhattisgarh. The project intends to contribute such
service inputs from the implementing agency outside the budget. Technical supported will be provided by a MIS
Coordinator. Also, tablets and other technical essentials will also be provided to team.

Community networks: Building on its existing community networks and partnerships through other projects in
district will ensure the active participation of local communities and stakeholders.

Utilization of previous materials: By utilizing lessons learned, best practices, and materials developed in
previous projects, Saathi will ensure a knowledge-driven and evidence-based approach in current program.

2.8 Key personnel

Provide a list of key personnel who will be critical in the management as well as the operational and financial
oversight of the proposed programme.
Name and position Relevant qualifications/experiences
Name: Bhupesh Tiwari 35 years of experience in social sector. Competency in rural marketing, rural
Position: President technology, organisational development, community mobilisation, and
development
Name: Harilal Bharadwaj 35 years of experience in social sector. Expertise in project operations, artisan
Position: Secretary mobilisation and technical expertise in terracotta, dhokra, and wrought iron.
Name: Pragati Tiwari Masters in development with 4 years of experience. She manages the project and
Position: Program exec. overlooks, reports, monitors, and performs as per the LFA.
2.8 Other (250 words max)
Human Resources in the project

1. Project coordinator
a. Planning and scheduling: making and keeping timetables, timelines, and plans for the project.
b. Communication and stakeholder management: Encouraging communication among project
participants, partners, stakeholders, and outside organization. This includes setting up meetings,
disseminating information, and sharing status and advancements of the project.
c. Coordination of outreach activities: The coordinator of an outreach project will oversee organizing
and arranging outreach activities like campaigns, workshops, events, and community engagement
programs. Liaising with local groups, and community may be necessary for this.
d. Capacity building: Capacity building and on-job training of village volunteers during SSV visits.
Organizing sensitisation workshops of various stakeholders on various maternal and child health issues
and advocating for increased notification of child and maternal deaths.
e. Monitoring and supervision: PC must make SSV visits to monitor and supervise the activities
f. Documentation and reporting: PC must keep thorough records of all project-related activities,
including minutes from meetings, emails, and reports.
g. Conflict management: Throughout the project, the PC must handle any problems or disputes that come
up. It might be among the village coordinators or with other stakeholders.

2. Sector supervisors – Four (1 per 25 villages)

a. Community mobilization: Through volunteers and field visits, will ensure mobilization of following
 PW in third trimester for ANC checkup on PMSMA days every month
  PW to AWWs for supplementary nutrition
 PW nearing their EDD to nearest health facility
 PW to CHC or DH for ensuring mandatory medical checkups of pregnant women by OB&GYN.
 Beneficiaries to VHSNDs
 SNCU discharged babies to SNCUs as instructed during discharge.
b. Health Education and Awareness: Inform and educate community members about topics related to
maternal health, including family planning, safe delivery practices, prenatal care, and infant care. Will be
done through workshops, awareness campaigns and one-on-one conversations.
c. Referral and Support:
 Tracking PW to ensure service delivery of critical care.
 Identification of danger signs in newborns and young child for timely referral to higher centre.
d. Advocacy and Community Engagement:
 Engage and participate with local leaders and stakeholders like PRI members, traditional healers,
SHG members to address systemic barriers to maternal healthcare.
 Advocate for conducting AAA meetings and Model VHSNDs.
 Advocate for male engagement in VHSNDs.
 Advocate for conducting Social Audits at village level to evaluate health system performance.
 Facilitate AWW for regularly monitoring the growth of newborns and infants.
e. Counselling and behaviour change:
 Adoption of spacing methods post-delivery.
 Institutional delivery.
 Stay for 48 hours post-delivery.
 Early initiation of breastfeeding withing 1 hour of delivery.
f. Documentation and Supportive Supervision:
 Perform online reporting of their activities and document their success stories.
 Keep an updated line lists of pregnant women including HRPs and children - newborns, young
children for HBYC visits, SNCU discharged babies, newborns due for HBNC visits
 Ensure early notification of maternal and child deaths.
 Facilitate filling up of HBNC and HBYC records.
 SSV visits to VHSNDs.

3. MIS Coordinator
 Overall data management of the project
 Managing the call centre for “Reaching every Delivery”
 Collection of monthly reports from project coordinator and sector supervisors
 Sharing monthly / quarterly report to UNICEF / Govt.
 Developing knowledge products / success stories / human interest stories based on field reports

4. Non - paid village volunteers – 200 (2 per village) – support the supervisors in their tasks in their village
3.1 Result statement: Every mother and child in project area receives the quality of care in pre and post-natal period through informed decision making and
empowered family and community members for improved health seeking behaviour.
Indicator Target Frequency Activity level budgets - cash
Programme Group Contributi Contribution
Activities
Outputs on from requested Total
partner from UNICEF
 Enumeration &  No. of PW in 3rd trimester identified PW of 3rd Monthly
enrolment of all 3rd  No. of HRP identified trimester
trimester PW  No. of PW enrolled against the RCH portal
 Ensuring the quality  No. of enrolled PW taking nutrition from AWW
Output 1: All medical care for PW  No. of enrolled PW received at least one ANC after
pregnant (ANC, possibly O&G enrolment in project
women and checkup)  No. of PW attended at least one PMSMA
newborn  Establishing linkages  No. of PW having at least one USG before delivery
receiving with Govt facilities for  No. of PW who are anaemic (<11.0 g/dl)
quality of care transport and blood  No. PW who has received IFA tablets
before and requirements  No. of enrolled PW having institutional delivery Women Monthly
around  Awareness for  No. of PW using transport provided by Govt. just
delivery with appropriate  No. of enrolled PW using any contraceptive method post- delivered
informed contraceptive delivery (IUCD/PPIUCD)
decision method Newborn Monthly
 No. of low-birth-weight newborn
making  Ensuring early
 No. of newborn with early initiation of breastfeeding
initiation of
 No. of mother / newborn identified with breastfeeding
breastfeeding
 Ensuring vaccination issues and referred
 No. of newborns received birth dose vaccination
for newborn
Output 2: All Mother Monthly
 Strengthening the  No. of newborn visited by Sector Supervisor
pregnant and
post-natal visits  No. of mothers sensitized at home for identifying danger
women and newborn
 Sensitization family signs of newborn as well as for themselves
newborn in post-
members for  No. of mothers using KMC in community for LBW newborn
receiving natal
identifying danger  No. of newborn received six HBNC visits by ASHAs.
quality of care period
signs of mother and  No. of children (<9 months) receiving 3 HBYC visits
in postnatal
newborn  No. of newborn received age-appropriate vaccination
period
 No. VHSND organized vs planned Health Monthly
 No. VHSND monitored by Govt. or Volunteers Facilities
 Streamlining the  No. PMSMA organized vs planned
Output 3:
follow up mechanism  No. of additional MCH care platforms – health camps,
Strengthening
in field special campaigns etc.
service
 Ensuring effective  No. of maternal deaths reported
delivery
service delivery  No. of child deaths reported
platforms and
platforms  No. of SNCU discharged babies followed up in field Children Quarterly
follow up
 Strengthening  No. of enrolled children who are stunted height for age) up to age
mechanism
growth monitoring  No. of enrolled children who are wasted (weight for height) of 9
 No. of enrolled children who are underweight (weight for months
age)

8
 Indicator Target Frequency Activity level budgets - cash
 No. of traditional healers engaged for MCH issues Group Quarterly
Output 4:
Engaging stakeholders  No. of PRI members sensitized on MCH issues
Engaging
Programme like PRI members,  No. of SHG members sensitized on MCH issues
stakeholders Activities
Outputs traditional healers,  No. of front-line health workers sensitized on gender - 10,46,000 10,46,000
for effective
SHG members,  No. of AAA convergence meetings organized
service
volunteers etc.  No. of beneficiaries attended the welfare camp
delivery
 No. of new beneficiaries identified for Ayushman card
Programme Activity X.1. In-country management and support staff costs, pro-rated to their contribution to the programme
18,27,000 31,92,000 50,19,000
Output X (representation, planning, coordination, logistics, admin, finance)
Effective and Activity X.2. Operational costs, pro-rated to their contribution to the programme (office space, equipment, office
3,36,000 63,000 3,99,000
efficient supplies, maintenance)
programme Activity X.3. Planning, monitoring, evaluation, and communication costs, pro-rated to their contribution to the
- 525,000 5,25,000
management programme (venue, travels, etc.)
TOTAL 21,63.000 48,26,000 69,89,000

3.2 Supply Contribution Plan

Complete the table below to provide the supplies (in Kind) require for programme implementation and responsibility for each partner to provide.
Item Details Provided by UNICEF/Partner No. of Price/unit Total Price
units
1.
2.
3.
Total Supply cost