Request for Proposal (RFP)

Improving Health Access and Empowering Rural Youth through Skilling in Agar Malwa, Madhya Pradesh

Baseline Study to assess the performance of key health indicators and existing skill levels, employability readiness, awareness of green jobs, and institutional capacity prior to the implementation of the 21st Century Skilling and Green Jobs Project in identified 27 Villages of District, Agar Malwa of Madhya Pradesh.

Issued by,
Smile Foundation

Deadline for receipt of proposals at Smile Foundation:

22^nd November 2025 

Study timeline- The study should be completed within 60 days from the date of contract signing

Submit your proposal- proposals@smilefoundation.email   

About The Organization

Smile Foundation was set up in 2002 by a group of professionals in New Delhi, India. It is a voluntary development organization that focuses on underprivileged children, youth and women. Currently, its interventions are directly benefitting over 15,00,000 children and their families every year, through more than 400 active welfare projects on education, healthcare, livelihood and women empowerment. Please visit our website www.smilefoundationindia.org for more information.

The Healthcare domain of Smile Foundation has been delivering comprehensive, community-centric primary healthcare services across underserved rural and urban areas since 2006. With a strong emphasis on accessibility, equity, and last-mile delivery, the Foundation has established a significant presence across 16 states and 73 districts, including 27 aspirational districts, reaching over 1 million individuals across 1,130 communities through more than 100 health projects.

The skilling domain of Smile Foundation brings over 17 years of experience in implementing large-scale skill development programmes across India, with a deep commitment to empowering underprivileged youth and aligning closely with national priorities like the Skill India Mission. The Foundation’s Livelihood Programme, conceptualized in 2006 and operational since 2007, began with a focus on retail sector placements and has since evolved into a robust, multi-sector skilling model addressing the dynamic needs of India’s youth.

Context and Background

(a) Health Project - The project is focused on improving access to quality primary healthcare services across 27 villages and Agar town in Agar Malwa district, Madhya Pradesh. The intervention seeks to address persistent health system gaps by delivering and complementing government initiatives at the community level, fostering preventive practices, and building a continuum of care.

Agar Malwa faces a dual burden of undernutrition and rising non-communicable diseases (NCDs), coupled with high anemia prevalence and adolescent reproductive health challenges. Despite high institutional delivery rates and antenatal care coverage, service quality, early identification of high-risk conditions, and follow-up care remain weak. The co-existence of undernutrition, adolescent health risks, and NCDs—amid limited access to routine primary healthcare—necessitates an integrated, community-based response.

The project adopts a comprehensive primary healthcare approach, guided by five core pillars: 

1. Decentralized Service Delivery: Ensuring consistent access to essential primary care services for remote communities through Mobile Medical Unit.
2. Preventive and Promotive Care: Early detection through mass screenings for anemia, malnutrition, and NCDs. These will be supported by growth monitoring, school-based adolescent health programmes, and Social and Behavior Change Communication (SBCC) activities aimed at improving health literacy and fostering healthy behaviors.
3. Continuum of Care and Referrals: A well-defined referral and follow-up mechanism will connect diagnosed cases to nearby government health facilities to ensure early intervention, continuity of care, and alignment with existing government services such as Ayushman Bharat and NPCDCS.
4. Convergence with Government Schemes: Aligned with national programmes including Anemia Mukt Bharat, WIFS, ICDS, and RMNCH+A.
5. Capacity Building for Local Health Systems: Orientation and training for frontline workers (ASHAs, ANMs, AWWs), PRI members, and VHSNCs to enhance last-mile service delivery, improve referral mechanisms, and strengthen local health governance. 

Outreach, facility-linked services, and coordinated community engagement to reduce out-of-pocket expenditures, improving early diagnosis, and promote healthier practices across all age groups, especially among women, adolescents, children, and the elderly.

By building a functional bridge between communities and public health systems, the project aims to transform primary healthcare delivery in rural settings, making it accessible, responsive, and sustainable. The initiative also sets the stage for replicable health system strengthening in similar low-resource geographies across India.

(b) Skilling: The proposed skilling program targeted, inclusive and future-ready skilling intervention to break the cycle of poverty, unemployment and underutilized youth potential. There is a clear and urgent need to establish structured, industry-aligned training programs that focus on trades with real market demand-especially in Green Jobs and 21st Century Skills such as digital literacy, communication and problem-solving. Investing in these domains will not only prepare the youth for the evolving employment landscape but also contribute to India’s larger climate and sustainability goals.

This project is designed to bridge the skill-employment gap by setting up a dedicated Skill Centre in Agar Malwa, conducting evidence-based trade selection, and delivering high-quality, NSQF-aligned training. Also training on 21st Century Skills will be provided to Youth through a Learning Management System (LMS). Special attention will be given to marginalized youth, women and migrant returnees, ensuring inclusive growth and livelihood security. The approach emphasizes community mobilization, gender-sensitive infrastructure, strong industry partnerships and post-training placement support-creating a holistic ecosystem for youth empowerment. 

Need of the study

Agar Malwa, a rural district in Madhya Pradesh, faces a complex public health challenge characterized by a dual burden of malnutrition and non-communicable diseases (NCDs), poor dietary diversity, limited women’s education, and persistent adolescent reproductive health issues. This necessitates a comprehensive community health intervention that is both preventive and promotive in nature.

Maternal and Child Health & Nutrition

• As per the National Family Health Survey (NFHS-5, 2019–21), 40.3% of children under five in Agar Malwa are stunted, 35.7% are underweight, and 18.7% are wasted—indicating both chronic and acute undernutrition.
• Further, 71.6% of children in the 6–59-month age group are anaemic, highlighting a major micronutrient deficiency issue.
• 55.6% Children under age 3 years breastfed within one hour of birth
• Only 0% of children aged 6–23 months receive an adequate diet, underscoring the severe lack of dietary diversity and feeding adequacy in early childhood, as confirmed by both NFHS-5 and the District Nutrition Profile (DNP, 2022).
• For women aged 15–49, 59.2% are anaemic, 26.7% are underweight, and 8.8% are overweight or obese, pointing to nutritional imbalance.
• Only 19.3% of women have completed 10 or more years of schooling, and 35.6% of women aged 20–24 was married before 18, reinforcing the need for interventions that target adolescent girls and delay early marriage.
• Moreover, 5.3% of girls aged 15–19 are already mothers or pregnant, placing them at higher health risk.

Maternal Health Services & Facility Access

• The district shows high coverage of institutional births (98.9%) and strong antenatal care (ANC) engagement, with 76.5% of women receiving four or more ANC visits.
• However, service quality and compliance remain gaps—only 54.8% of pregnant women consumed IFA for 100+ days, and 44.6% completed 180+ days, far below recommended levels.
• Access to basic amenities also plays a role. While 81.4% of households have improved drinking water and 72.3% have improved sanitation, only 39.5% use clean cooking fuel, exposing households to indoor air pollution and respiratory hazards.
• Moreover, 58.9% of households have some form of health insurance, reflecting progress in financial access but also scope for further expansion under schemes like Ayushman Bharat.

Non-Communicable Diseases (NCDs)

• 19.5% of women and 18.9% of men have high or very high blood sugar levels (indicative of diabetes or pre-diabetes).
• 21.2% of women and 25.2% of men have elevated blood pressure, indicating a growing incidence of hypertension.
• 40.7% of women have high-risk waist-to-hip ratios, a proxy indicator for cardiovascular and metabolic risk. 

These NCD risks are exacerbated by low awareness, poor lifestyle practices, and limited screening at the community level, especially in rural and tribal pockets. Early identification, lifestyle counselling, and frontline monitoring are largely absent from routine service delivery, even though these are essential to prevent long-term complications and economic burden.

While anecdotal evidence and secondary data highlight critical gaps, there is a pressing need for context-specific, primary baseline data to: 

• Understand the current status of anemia prevalence, NCD burden, Measuring the out-of-pocket healthcare expenditures incurred by the community. Service access gaps, and health-seeking behaviors, healthier practices behaviors across all age groups, especially among women, adolescents, children, and the elderly.
• Measure the reach and effectiveness of existing maternal health and nutrition services, including ANC, PNC.
• Identify bottlenecks and gaps in knowledge, behavior, and service utilization at household and system levels.
• Generate disaggregated insights across vulnerable groups (SC/ST, remote hamlets, adolescent mothers, etc.) to inform equity-focused interventions.
• Provide evidence-based benchmarks for monitoring project impact and enabling mid-course corrections during implementation. 

The findings from this baseline will support strategic decision-making, strengthen programmatic focus, and enhance convergence with government systems to improve maternal and child health outcomes in the intervention geography.

Objectives of the Study

Healthcare

Overall ObjectiveTo establish a comprehensive baseline on the current status of maternal, child, and reproductive health; prevalence of anaemia and non-communicable diseases (NCDs); nutritional status; health-seeking behaviours; and access to essential health services among communities in the 27 identified villages of Agar Malwa district. This baseline will serve as a reference point to monitor and evaluate the effectiveness and impact of the planned health interventions.

Specific Objectives

1. Maternal, Child, and Reproductive Health

• To assess the current status of maternal, child, and reproductive health indicators, including access to and utilization of antenatal care (ANC), postnatal care (PNC), immunization, and family planning services.

2. Nutritional and Health Status

• To determine the prevalence of anemia among women, adolescents, and children.
• To assess the nutritional levels and dietary practices across different age and gender groups.

3. Non-Communicable Diseases (NCDs)

• To assess the burden and prevalence of common NCDs such as hypertension, diabetes, and cardiovascular diseases within the community.

4. Health-Seeking Behaviours and Practices

• To understand the community’s health-seeking behaviours, awareness, and adoption of healthier lifestyle practices across all across different age and gender groups. particularly among women, adolescents, children, and the elderly.
  
  

5. Access to and Utilization of Health Services

• To identify gaps in access to and utilization of essential health services, including maternal and child health, nutrition, and NCD management services.
• To assess the quality, availability, and reach of existing healthcare infrastructure and frontline health workers in the identified villages.
  
  

6. Economic Burden and Expenditure

• To measure the extent of out-of-pocket (OOP) health expenditures incurred by households and their impact on healthcare-seeking decisions and financial protection.
  
  

7. Baseline for Monitoring and Evaluation

• To establish benchmark data for key health and nutrition indicators that will enable monitoring of changes and evaluation of the project’s effectiveness and impact over time.
• To suggest the key interventions, measurable midline and endline impact indicators in line with SROI. 

To monitor the effectiveness and impact of the intervention, a baseline study is being undertaken.

This study will assess the current status of Maternal, child and reproductive health, anemia prevalence, NCD burden, Measuring the out-of-pocket healthcare expenditures incurred by the community, nutrition levels, service access gaps, and health-seeking behaviors, healthier practices behaviors across all age groups, especially among women, adolescents, children, and the elderly. Health Outcomes and access to essential services such as ANC, PNC among Pregnant Women in in identified 27 Villages of District, Agar Malwa.

To monitor the effectiveness and impact of the intervention, a baseline study is being undertaken for Skilling project.

For detailed information, please check the complete version of the RFP attached below.

Job Email ID: proposals(at)smilefoundation.email

Download Attachment: RFP_ Baseline study-Health & Skilling_Smile Foundation.pdf