Background: In the climate-vulnerable Sundarbans, West Bengal, environmental stressors like salinity intrusion exacerbate perinatal risks. This study evaluated a three-year health system strengthening intervention (2022–2025) on the knowledge and practices of Frontline Health Workers in Namkhana (intervention) versus Patharpratima (control) blocks. Methods: A cross-sectional study was conducted following a capacity-building program (2022–2025), 26 Frontline Health Workers (14 intervention, 12 Control) were evaluated after the capacity building programme to corroborate service delivery. Data on High-Risk Pregnancy (HRP) identification and Antenatal Care (ANC) protocols were analysed using Fisher’s Exact Test. Results: Intervention health workers demonstrated higher clinical identification of pre-eclampsia (92% vs. 67%) and severe anaemia (92% vs. 85%). Immediate facility-based treatment for high-risk cases was significantly higher in the intervention arm (92.9% vs. 41.7%, p=0.01). A significant knowledge gap identified regarding early pregnancy registration in intervention group (42.9% vs. 91.7%, p=0.015). Conclusion: The intervention successfully enhanced High Risk Pregnancy management capacity in a disaster-prone region. The disparity in registration knowledge suggests that intensive clinical training must be balanced with routine procedural reinforcements. Future interventions should prioritize on-job mentorship and visual contextual tools to integrate emergency management with routine Antenatal Care for improved maternal outcomes.
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