Akshada (Rajasthan)


Improving maternal and child health and nutrition in Rajasthan

Akshada (Rajasthan)

In 10 seconds


To significantly improve Rajasthan’s status in maternal and child health and nutrition

Program Partners

Government of Rajasthan, Tata Trusts


Rajasthan; Focus districts - Jhalawar, Baran


Pregnant women, mothers, children

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Our interventions in the Akshada program are classified into three broad areas. The first set of interventions targets every aspect of healthcare service delivery. Second, interventions aimed directly at the community to create awareness and make it easier for women to demand quality health services. Finally, positive advocacy to remove barriers to implementation, strengthen health systems and shape policy.

* Baran, Rajasthan

Interventions that target every aspect of healthcare service delivery

AAA Platform

Meet the three women responsible for health delivery in a village

Three women government health workers are responsible for delivering health and nutrition services in India’s villages. Each village has an Auxiliary Nurse Midwife (ANM), ASHA (Accredited Social Health Activist) and Anganwadi worker (AWW). Each of these frontline workers has distinct but related roles, and they work in the same villages. All too often, they do not collaborate enough. The AAA (ANM-ASHA-AWW) platform brings them together.

Read the story →

Integrated AAA app

The app enables instant real-time data sharing between the AAA frontline workers. This one-of-its-kind solution was adopted by the Government of Rajasthan for scale-up in 2017.

Rationalised Registers

We suggest that you begin by watching this video.

Frontline workers (AAA) maintain numerous, voluminous registers. For instance, the Anganwadi Worker alone has eleven. Several of them contain repetitive fields. Naturally, AAA saw registers as a burden. We saw it as a job-aid.

We worked with designers and government functionaries to make the Auxilary Nurse Midwife’s service delivery register easy to use. We eliminated repetitive columns, introduced a logical sequence and made it visually appealing. It helped to save time, improve data quality and morale of health workers.

In April 2017, the new register was adopted by the State Government for roll-out across the state. This effort also formed the basis for the integrated AAA app.

Nurse Mentoring

Each Community Health Centre (CHC) caters to approximately eighty thousand people. Our nurse mentors work to ensure that labour room facilities and personnel at high case-load delivery points are well-equipped to handle deliveries.

There are two sub-components:

Facility enhancement: Includes labour room organisation, ensuring availability of essential drugs and equipment and proper display of posters and educational material.

Skill building: Observation and training of nursing staff to enable them to enhance their skills.

Watch this videoto know more.


Auxiliary Nurse Midwives (ANMs) typically serve a population of five thousand across few villages. Some of them have to travel to inaccessible areas. To ease their burden and improve efficiency, six ANMs were provided with scooties in December 2015. The event was presided over by the Hon. Chief Minister, Smt. Vasundhara Raje.

2. Interventions targeted directly at the Community to help shape the demand for healthcare services

Jagori Kishori – Adolescent Girls Program

We work with adolescent girls to mobilize community demand for health services. Participants are trained on maternal and child health issues. Then, they visit beneficiaries’ houses and reiterate key messages.

This intervention is in its infancy and we’re working on developing a scalable model.

    3. Interventions that help build an enabling environment for the overall suite of interventions

    Stanford University Partnership

    Bringing knowledge from one of the world’s leading medical schools to people serving in the most difficult contexts

    In December 2016, Stanford University, the Govt. of Rajasthan and The Antara Foundation came together to ink a historic MoU. The MoU proposes collaboration between the three parties for enhanced quality and greater access to medical education in Rajasthan through high-quality digital content produced by Stanford University’s Digital MEdIC initiative.

    Stanford lessons and content have been integrated with the Jhalawar Medical College’s curriculum. Engaging audio-visual content has also been made available to frontline workers in Rajasthan to aid them in educating beneficiaries.

    Please watch this video to know more.

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    Impact and scale

    * Aerial view - Jhalawar


    Akshada views impact with respect to the following objectives:

    • Increase collaboration, coordination and data synchronisation between the three front-line workers
    • Increase identification, follow-up and referral of critical beneficiaries
    • Enhance the quality of services provided by front-line workers to beneficiaries by improved record keeping, increasing efficiency & effectiveness of service delivery
    • Improve labour room management and enhance skills of nurses deployed in labour rooms
    • Improve the demand for nutrition and health services and to enable adolescent girls to act as change agents within their communities

    The program is deploying several innovative and path breaking interventions that are designed to be scaled up in partnership with the Government-run public health system. This ensures not only rapid scale-up during the period of the Akshada program but also the sustainability of the program in future. While there is a lot of room for improvement in outcome indicators for Rajasthan, the state is taking progressive steps to emerge as a beacon for maternal and child health. Under the program, over 2,700 villages have been mapped in Jhalawar and Baran districts.

    Frontline workers and supervisors in every village across Rajasthan have been trained on the AAA platform. Every ANM in the state uses a service delivery register developed with our inputs


    Scaling up of AAA Platform across Rajasthan


    1. Identification of Under-5 Malnourished children went up by over three times

    Why the increase?

    • Data integration increased from 57% to 94%, highlighting more lost/ left-out cases
    • Malnourishment screening went up from 20% to 76%, increasing coverage of identification

    2. Identification of children under-5 who are under-weight went up by 117%

    Why the increase?

    • Data integration increased from 57% to 94%, highlighting more lost/ left-out cases
    • Weighing of children went up from 70% to 97%, increasing coverage of identification

    3. Identified high risk pregnancies increased by over 60%

    Why the increase?

    • Data integration increased from 57% to 94%, highlighting more lost/ left-out cases
    • Knowledge scores of AAA on high risk pregnancies increased from 43% to 67%

    Note 1: According to Rajasthan government estimates, 10-15% of pregnancies are at high risk

    Note 2: Outcomes based on monitoring done in 80 AWCs for ~800 pregnant women in Jhalawar district, Rajasthan in 2018

    Upd Oc

    Measurable Impact - Akshada Program’s Impact in Rajasthan

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    Program Updates

    Along with quality and coverage, speed is all-important in our scale mantra. Follow this space to know the latest developments.

    * Jhalawar, Rajasthan