Supporting Frontline Workers In Early Childhood Development

India’s quest for sustainable development and health equity is difficult to succeed without significant strides in the Early Childhood Development as infant and maternal mortalities are big markers of development of the nation. Hence frontline community health workers such as Anganwadi Workers (AWWs), ASHAs (Accredited Social Health Activists), and ANMs (Auxiliary Nurse Midwife) play a pivotal role. These workers, often hailed as A-A-A, are the backbone of public healthcare in India.

The Role Of Anganwadi Workers

Anganwadi workers/sevikas are frontline health workers providing services to children and their families through the Integrated Child Development Services programme. Although being sponsored by the Central Government, the implementation of the scheme falls under the ambit of State Government/UT administration.

There were 13,48,135 AWWs and 10,23,068 Anganwadi Helpers (AWHs) in the country as on 31st of December 2023, as indicated in the Ministry of Women & Child Development (MWCD) press release dated 07/02/2024. Their direct engagement with communities, especially in rural areas, enables them to identify, prioritize, and address ECD-related issues. Their responsibilities range from providing basic health care and nutritional advice to disseminating knowledge about child development milestones and the importance of mental and emotional well-being of the caregivers.

Why Are Anganwadi Workers Crucial Stakeholders?

Anganwadis are the focal point for implementation of all the health, nutrition and early learning initiatives under ICDS. Anganwadi centers primarily cater to children aged 0–6 years, serving as vital components of India’s public healthcare system. AWWs have unparalleled reach in communities, especially rural areas. They are often trusted voices in their communities, hence making their advice invaluable. Building the needed rapport with families, it is natural to see them becoming familiar faces and source of reliable information. They can effectively promote positive behavior changes within families.

AWWs are the trained community health workers (CHW) for administering the intervention within the realm of the project here at Mahatma Gandhi Institute of Medical Sciences. Markedly, they tick many boxes such as being the go-to CHW for the rural communities in case of any developmental related concerns, with nutrition and health more critically being monitored by the ASHA and ANMs; access to the children via the Anganwadis, and allowing a robust feedback mechanism from the project team.

Workload

AWWs often have a heavy workload, limiting the time they can dedicate to such time-intensive ECD interventions. High workloads and low recognition demotivate the sevikas. The Anganwadis operate from 10am to 2pm. Most of them being housewives, hardly get significant time at their own homes for their daily activities, as a result of their schedule of home visits. The project team faced this conundrum, where the AWWs are essentially being forced to increase their workload without any incentives. Especially, considering that the team trains them to conduct assessments in the existing home visits, that have not been ratified by the system/ICDS at scale. Hence, to garner some agency on the behalf of the AWWs, a portion of the funds is reserved for them as an incentive for participation. Currently, a thousand rupees is given as an incentive every month to these AWWs.

Quality interaction with even a single child’s caregiver should takes a minimum of 25 mins. The AWWs are motivated to conduct at least one assessment of every child under 3 years of age in their villages. However, observation says that the typical rate is around 2-3 children per month. This number reduces further for more distant villages. A significant challenge towards higher adoption of the new tool in the system is in increasing this unit number. Thereby, lending further impetus in optimizing their daily workloads.

Renumeration And Benefits

As per current guidelines, the AWWs are paid 10000INR per month honorarium for their services. This is following several protests by the AWWs from various states in the last few years that a hike was instituted in their payrolls. Couple this with frequent delays and payment failures through the authorities, and you get their frustrations. Do take into consideration that many of these women are engaged in this role on a full-time basis.

AWWs and AWHs engaged with the Covid-19 related tasks, have been provided with insurance cover of INR 50 lakh under the Pradhan Mantri Garib Kalyan Package with certain conditions. The Pradhan Mantri Shram Yogi Mandhan (PM-SYM) Pension Scheme, a voluntary and contributory pension scheme for the unorganized sectors in the country to ensure old age protection has been criticized for being exclusionary and misrepresentative with special conditions and areas of contention hidden in confusing terms by the All India Federation for Anganwadi Workers & Helpers (AIFAWH). Consequently, it seems that the government is learning from its missteps and has tried to address them.

Transparency And Governance

IT systems have been leveraged to strengthen and bring about transparency in delivery support systems at Anganwadis under ‘Poshan Abhiyaan’. The MWCD rolled out the ‘Poshan Tracker’ application on 1st March, 2021 as an important governance tool. The system aims to empower the AWWs via in digital monitoring and ease of data collection via smartphones. The mobile application has digitized and automated the physical registers used by AWWs.

However, reality is often misleading. While spending time on field with the AWWs, it was evident that they were lacking the required hands-on-training to operate these new systems in relaying their responsibilities. Many of these workers have just been able to complete primary schooling, hence, expecting them to learn on the job is not optimum.

There is an urgent need for comprehensive training programs that equip AWWs with specialized knowledge in ECD. Strengthening these components in the ICDS system by imparting the necessary training to the workers is one of the critical outcomes of the current project. CHWs have received training on various aspects of ECD including interactions in developmental domains. This knowledge base equips them to educate families on current practices and identify potential developmental delays and catch advancing disabilities. They can identify children facing developmental delays or at-risk situations and connect them with appropriate services. The intervention has been integrated into existing usual care based monthly home visits delivered by the AWWs

The Way Forward

Concerted efforts from the government, non-governmental organizations, and the wider community are absolutely critical towards empowering the AWWs. Investments in their training, remunerations, resources, and recognition, alongside strategies to further bolster openness in engagements with them, are critical. We can ensure a brighter future for its children and, by extension, its broader socio-economic landscape. provided these champions of community are nurtured and respected for their services. Their role in shaping the overall development of children lays the foundation for a stronger, healthier, and more equitable India.