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Community Volunteer Initiative, Tamil Nadu
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Subject Area="Behavioural Change Communication." Objective="Community health workers."
Details for Reform Option "Community Volunteer Initiative, Tamil Nadu"

Background: A lack of effective health education in rural/isolated communities leading to poor health and nutritional status of children and pregnant and feeding mothers. The problem was worsened by poor use of primary health centres and Anganwadi Centres (ICDS Centres). Action: The Tamil Nadu Science Forum (a local NGO, using funding from UNICEF) started the Arogya Iyakkam programme. They trained unpaid volunteers in each village to look after 125 families each with children under 5 years old. They followed them from pregnancy through to pre-school period in the hope of bringing about behavioural change. They discussed various issues and problems within the family and counselled them on a full range of subjects linked to health and nutrition of the children. They also weighed and measured the nutrition status of the children and encouraged the parents to make better use of existing health services. Each volunteer was supported by a motivated and trained full-time woman who looked after ten volunteers. A village health committee was formed with a number of women members along with elected Panchayat leaders to manage and monitor the project. Results: The programme was evaluated using data collected from the village health registers between May 1999 and February 2001. In the first 18 months of the programme, of 8,536 children (from 30,041 families in 197 villages) weighed, the percentage of children with a ‘normal’ weight increased from 36.25% to 46.69% - an overall increase of 10.5 %. It was identified that in some villages there was a strong intervention by the volunteers but in others there was no intervention and these villages were used as a control to monitor the programme. In ‘control’ (comparison) villages, the increase in percentage of children of ‘normal weight’ was 3.29%. In villages where there was effective intervention the percentage improvement was 15%. Number of village health activists trained: 238

Cost INR 1.5 lakh per year for 60 villages or INR 2 per head of population covered.
Place 387 villages in 7 blocks from four districts in Tamil Nadu from May 1999 to February 2001. Funding (from UNICEF) was extended to February 2002 and has continued since with local support.
Time Frame Seven months to establish contacts, funding and setting up self help groups in the villages. Took a further two years to implement in each village.

Personalised approach: The programme ensured that each family was counselled individually based on their needs and their problems and supported with repeated visits. They were also linked to the VHN and the ICDS. Inclusive: The personalised approach meant that the whole family was involved. Behavioural change strategy: Good instrument for awareness raising throughout the community with more focus on education leading to behavioural change. Strengthens links: between health and Integrated Child Development Services (ICDS) workers. Health promotion: Appears to have positive effects on nutritional status and therefore, no doubt, on child survival prospects. Community ownership: Achieves significant community involvement in health/ nutritional issues and thus ownership. In this sense, reliance on non-paid volunteers is a strong-plus point.


Funding: Possibly dependent on upfront donor funding to initiate action on a very large scale (though it seems that the social welfare department has adopted this approach without external funding). Volunteer reliant: The fact that the system depends on the goodwill of volunteers may have negative repercussions if local enthusiasm flags.


Willingness of local community to participate.

Who needs to be consulted

NGO (in this case Tamil Nadu Science Forum), State Government, Panchayat members, ICDS, DH&FW.



The scheme is based entirely on volunteer action so sustainability is reliant on their good will. They need good support and encouragement but are largely sustained by their increased status within the community.

Chances of Replication

This methodology has now been taken up by ICDS and by the Tamil Nadu H&FWD in a further series of districts. The model has also been replicated in Chattisgarh. Has since been extended and is being continued in 17 districts by the Tamil Nadu State Government.


The project was accepted by the community and it proved that using an individual family ‘problem-centred’ approach to IEC activities can be highly successful. UNICEF chose the programme as one of its 10 best programmes in the world and recommended it as a model to the State Government.


Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi. September 2004.

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