Assessment of Integrated Child Development Services (ICDS) at Grass Root Level in an Urban Area, Raigad District, Maharashtra

Background: ICDS is an integrated program intended for Maternal and Child Care which adopts a holistic, lifecycle approach. Its main focus is on health, nutrition and education. Urban ICDS caters to the vulnerable urban slum population. Despite the program running for four decades its impact on its beneficiaries is still slow. The Anganwadi worker and helper are the grass-root functionaries running this program through Anganwadi centre. Hence this study was conducted to assess the functioning of the Anganwadi centre. Methodology: A Descriptive Cross-sectional study was conducted at all 15 urban-ICDS Anganwadi Centres of Khopoli during September-November 2019. The Anganwadi workers and helpers were interviewed regarding their sociodemographic details, knowledge and challenges perceived to run the centre. Observational Checklist designed based on guidelines and standard proforma for monitoring of the ICDS projects was used to assess infrastructure, equipment and registers. Results: Out of 14, 11(78.57%) Anganwadi workers had more than a decade experience. Indoor space of 600 sq.ft was available in 7(46.67%) centres. Toilets with running water were available in 9(60%) Anganwadi Centres and 6(40%) were linked to the school. Functional Salter’s weighing scale was available in 11(73.33%) Anganwadi centres. All 12 registers were available in 9(60%) Anganwadi centres. The utilization of services by pregnant women was the highest. Partially immunized children were present in 2(13.33%) Anganwadi centres. The service gap was highest (100%) with health check-up. Conclusions: There is a gap in the availability of infrastructure and utilization of some services. Keywords: urban ICDS, Maharashtra, Service gap.

Anganwadi worker time use in Madhya Pradesh, India: a cross-sectional study

Background Anganwadi Workers (AWWs) are a group of 1.4 million community health workers that operate throughout rural India as a part of the Integrated Child Development Services program. AWWs are responsible for disseminating key health information regarding nutrition, family planning, and immunizations to the women and children in their catchment area, while maintaining detailed registers that track key beneficiary data, updates on health status, and supply inventory beneficiaries. There is a need to understand how AWWs spend their time on all of these activities given all of their responsibilities, and the factors that are associated with their time use. Methods This cross-sectional study conducted in Madhya Pradesh, collected time use data from AWWs using a standard approach in which we asked participants how much time they spent on various activities. Additionally, we estimated a logistic regression model to elucidate what AWW characteristics are associated with time use. Results We found that AWWs spend substantial amounts of time on administrative tasks, such as filling out their paper registers. Additionally, we explored the associations between various AWW characteristics and their likelihood of spending the expected amount of time on preschool work, filling out their registers, feeding children, and conducting home visits. We found a positive significant association between AWW education and their likelihood of filling out their registers. Conclusions AWWs spend substantial amounts of time on administrative tasks, which could take away from their ability to spend time on providing direct care. Additionally, future research should explore why AWW characteristics matter and how such factors can be addressed to improve AWWs’ performance and should explore the associations between Anganwadi Center characteristics and AWW time use.

Recasting Food

Integrated Child Development Services (ICDS) is the principal programme operating in India to address issues around child development, malnutrition and pre-school education. A package of services – including the Supplementary Nutrition Programme (SNP), pre-school education, immunization, health check-ups, referral services, and nutrition and health education – are provided through an Anganwadi Centre (AWC) with an Anganwadi Worker (AWW) and an Anganwadi Helper (AWH) for roughly every one thousand people. From the mid-1990s, there have been successive efforts on the part of the Government of India to universalize ICDS, and there has been a multi-fold increase in funds allocated to this programme between the 8th Five-Year Plan (1992–93 to 1996–97) and the 12th Five-Year Plan (2012–17) (1-2). However, the utilization of all services under ICDS continues to be grossly low. Close to 75 percent of children aged 0–71 months in the areas covered by AWCs did not receive any supplementary food from the centres, and less than 12 percent of children received supplementary food ‘almost daily’. For children aged 36–71 months this figure is 15.5 percent. More than 80 percent of children were not weighed at all. It has been reported that children belonging to economically backward and socially marginalised families, including Dalit, tribal, and religious minorities, are excluded from utilising these services through unfavourable institutional rules and structural factors. Equally, members of well-off families do not use services provided by AWCs – especially the SNP – for under-6 children. A multi-sited ethnographic study was conducted in four villages in Gujarat in order to identify the reasons behind poor utilisation of AWCs, especially the SNP services. The study aimed to understand everyday experience of households around the SNP in rural settings and an opportunity to study AWCs as institutions embedded in the context of village cultural life. The authors hypothesise that a study focusing on AWCs could serve as an illustrative case to highlight challenges in implementing other entitlement-based programmes.

Knowledge of anganwadi workers about integrated child development services: a study in Sitamarhi district of Bihar, India

Background: The anganwadi worker (AWW) is the backbone of integrated child development services (ICDS) for delivering the services of the program. Being a key functionary, her level of knowledge regarding various components of ICDS is linked to the ultimate outcome of the ICDS program. Thus, this study was aimed to assess the level of knowledge among AWW regarding services of ICDS.Methods: This was a cross sectional study in which level of knowledge regarding ICDS among anganwadi worker was assessed using structured questionnaire. The primary outcome of the study is the knowledge of AWW about ICDS component services. Descriptive statistics was presented as frequency and percentage for categorical variable. The knowledge of AWW was assessed by knowledge score made under all the themes of the questionnaire and was presented as mean and median score. Analysis was done in STATA version 14.2.Results: Nearly 55% of the respondents were not aware about ICDS services. Whereas majority had knowledge on growth monitoring and immunization respectively, above the median score, only 39% of AWW had knowledge on nutritional supplementation above median score. The variables such as education level and training of AWW showed significant association with the knowledge of ICDS components.Conclusions: There is need for improving knowledge and awareness about various ICDS components and the training quality provided to AWWs.

A cross sectional study to assess the infrastructure and logistics available at Anganwadi centres in a rural area

Background: ICDS is running from about last four decades in our Country sponsored by Central Government. For achievements of ICDS objectives Anganwadi Centres need to be well equipped in infrastructure and logistics as they are the main source of services provided under ICDS. To find out available infrastructure and logistics at Anganwadi Centers (AWCs), to study the bio-social profiles of Anganwadi Worker (AWWs) and to assess the factors affecting the organizing ‘matriya samiti’ meeting by AWWs at AWCs.Methods: A cross sectional observational study conducted in a rural area of district Bareilly in 22 Anganwadi Centres selected by multi-stage sampling technique. Selected Anganwadi Centres were visited and selected Anganwadi workers and beneficiaries were interviewed.Results: Majority of AWCs were having pucca type of construction but only 18% were having toilet facility. 60% of AWCs were having regular supply of supplementary nutrition, 72% of AWCs do not have any cooking utensils, around 55% were having growth charts, only 32% were having complete non formal pre-school education kit, less than 40% were having complete medicine kit and only 13% were having referral slips.Conclusions: Most of the AWCs were not having adequate infrastructure and logistics as requires.

Assessment of knowledge and skill of sahiyya (ASHA) and anganwadi worker on appropriate usage of mother and child protection card in Ranchi, Jharkhand: a cross sectional study

Background: Mother and child protection card (MCP card) is a common card to maintain the record of health care delivery including antenatal care, post-natal care and care of the child that can be used by both the health personnel and the beneficiaries. This study was done among Sahiyyas and AWWs to assess their awareness about MCP card, to find out their training status, to assess their knowledge and skill in recording information in MCP card and assess their role perception of MCP card.Methods: A multi-stage stratified random sampling method was adopted to select Sahiyyas and AWW’s for interview between November 2017 – April 2018 (6 months). 17 Sahiyya and 19 AWWs were interviewed using a pre tested schedule. Templates were generated in MS Excel sheet and data analysis was done using SPSS software (version 20).Results: All the Anganwadi workers who were included in this study were aware about the MCP card whereas 15 out of 17 sahiyyas had awareness about the existence of MCP card. Training in order to orient the AWW and Sahiyya about using MCP card was very low, only 6 out of 19 (31.6%) of AWW had received training and 8 out of 17 (47.1%) Sahiyya’s were trained. We found that majority of the workers and Sahiyya had knowlwdge about most of the sections and had used it to record information in MCP card.Conclusions: Sahiyya’s and AWWs were aware about existence of MCP card, and most of them use it, despite very low training status.