The uptake of health & nutrition programme by the PVTGs is very low. Cultural factors followed by the long distance to cover owing to the geographical remoteness and belief in indigenous system of treatment explain most of the reasons for non-utilization. Significant mistrust between tribal communities and service providers who are largely non-tribal, weak demand and non-responsive supply chain become barrier for the planners, programmers and functionaries in delivering the health care services to the PVTGs. Hence the interventions to enhance the uptake of different health & nutrition related programme by PVTGs should be sensitive enough to have some relevance to their culture. There is huge cultural difference among the PVTGs also. So, a particular approach that works for one PVTG will not work for others. Programmes should be designed according to their need and cultural context. Functionaries of different departments working closely with these PVTGs need to understand the intricacies of their culture as well as the technical stuff to render help to these communities at the time of need. Hence, training of these functionaries becomes necessary to build their capacity.
The present study was carried out to provide technical support and capacity building of different stakeholders working closely with the PVTG communities in 12 districts of Odisha. Through six intensive training programmes, 242 stakeholders were trained to be trainers for the frontline workers.
In our study, the knowledge score (mean) of all stakeholders was significantly improved after training as compared to before training (13.79 ± 3.78 vs 11.5 ± 5.2, p value = 0.001). Similar increase in knowledge was seen in a study conducted by Nelson BD et el on the frontline maternal, newborn and child health workers in South Sudan. In their study, the improvement in score was from 62.7%±20.1% pre-training to 92.0%±11.8% post training (p value < 0.001) 
The pre-test result for the overall knowledge was low among OPELIP staff with mean score of 8.41 ± 3.03. As OPELIP staffs are involved more in livelihood programmes like agriculture, horticulture, fisheries, animal husbandries etc, they have less technical knowledge in the field of health and nutrition. On the contrary, the knowledge in OLM staff was quite good with mean score of 11.41 ± 3.42 even though their exposure to health & nutrition technicality is similar to OPELIP staff. The pre-test findings for health functionaries (Public Health Extension Officers) were strangely lower (Mean score 9.16 ± 2.49) than other stakeholders except OPELIP staff. But, the post-test scores of health functionaries were highest in all domains and the overall increase in knowledge was statistically significant (pre-test 9.16 ± 2.49 Vs 15.48 ± 4.19, p < 0.0001). A study conducted by Khyati FN et el, amongst community health workers in Indonesia documented a significant improvement in knowledge regarding management of children with cough and breathing difficulties amongst those were trained (p value < 0.05). As ICDS supervisors work mostly for under-5 children, their knowledge in child malnutrition was better than other stakeholders in pre-test assessment and there was significant improvement in knowledge after the training. But their knowledge was low in the domain of communication in service delivery. This may be due to their less direct interaction with the beneficiaries like under-5 children and mothers. In this study the knowledge regarding newborn care was significantly increased from 46.7–75% whereas in a study conducted by Batra K et al the post test knowledge improved to 100% . Feedback on different aspects of training like duration, quality (teaching skill of resource persons, A-V aids) and content of the training was obtained from all participants. All participants were of opinion that the training had appropriate and useful content and the trainings were of good quality. But 15% of the participants opined that the duration of the training was short. The study by Tawfiq E et el have also shown that regular training of health care workers can improve quality of care of under-5 children . In-service and pre-service trainings are required by the stakeholders working in the field of nutrition and health as these are ever evolving subjects. A study by Ameh et el recommended in-service & pre-service emergency obstetric and new-born care training for health care providers for better maternal health outcomes. But these emergency obstetric and new-born care trainings are lengthy and more intensive than the trainings we conducted for the stakeholders . Study conducted by Bredfelt et el have found that training improved electronic health records (EHRs) skills of health care providers. The training sessions consisted of short lectures and demonstrations (20–40 minutes) were interspersed with hands-on directed activity. The training methods were similar to ours but the duration of training was shorter in their case. Another plus point in their trainings was that, those were conducted in live HER environment which might have resulted in better results in terms of outcome .
The stakeholders working for PVTG communities in 12 tribal districts of Odisha were being trained by government and other developmental agencies from time to time. But the strength of this study was that it was a first of its kind of training for these stakeholders as this training covered all the aspects of child health, adolescent health, maternal health, communication strategies and different programmes by state government of Odisha and central government (Governemnt of India) for newborn, children, adolescent, eligible couple, antenatal, postnatal women and lactating mother. This training would equip the stakeholders with the required knowledge and skill to deliver quality health & nutrition services to the PVTGs and as Front-Line Workers (FLWs), local leaders and traditional healers would be trained subsequently, the communication gap between the PVTGs and non-tribal service providers would be filled up. The project has a component of monitoring of the trainings of FLWs. Hence the rolling out of the programme would be reinforced and quality of training would be good. Post-test assessment was carried out immediately after training which might have resulted in an increase in the level of knowledge among the participants may be a limitation for the study.