A study to compare work profile of Rural and UrbanAnganwadi Workers in Bangalore.

Introduction

Integrated Child Development Services Scheme (ICDS) is India’s response to the challenge of breaking a vicious cycle of malnutrition, impaired development, morbidity and mortality in young children¹ . Anganawadi Centre(AWC) is a point of contact to deliver supplementary nutrition to many beneficiaries such as Antenatal, postnatal mothers and Under 6 year children at grass root level in the community² . Anganwadi workers (AWW) are recruited as perguidelines of ICDS which isat least 10th pass and from same locality to improve the service delivery through familiar face in the community.³ AWW along with ASHA workers and Auxiliary Nurse Midwives(ANM) conduct various activities like immunization sessions, antenatal check-up and Village Health and Nutrition day.⁴ The performance of AWW depends on skills like rapport development with beneficiaries, understanding factors such as knowledge of ICDS programme, concern about child safety and quality of supplementary nutrition.⁵ Smooth delivery of services depends on education, experience, locality and training of Anganwadi workers(AWW) which in turn affect nutritional status of beneficiaries.⁶ Hence, this study was undertaken to compare the work profile of Anganawadi workers of urban and rural Bangalore.

Materials and Methods

Study setting: This study was conducted in urban and one randomly selected rural field practice area, department of community medicine, Bangalore Medical College and Research Institute.

Study participants: All the Anganwadi workers in both areas were included for the study.

Data collection Technique: Written informed consent was taken for all participants before data collection process. Data was collected using pretested semi-structured questionnaire⁷ by interviewing anganawadi workers.

Data Analysis: Data was entered in MS Excel 2016 and analysed using SPSS software version 23. Chisquare test and Fischer exact test was used and p values <0.05 considered significant.

Results

The service rendered by Anganwadi workers in Urban and Rural Anganawadi centres (statistically significant p<0.05).(Table.1) Most of the Anganwadi workers underwent training before joining the work and attended refresher course in different timelines in topics like Antenatal care, Pre-school education and Supplementary nutrition to children. (Table 2 and 3).

The mean time spent by Anganawadi worker in different activities like preschool education, Record maintaining etc was studied. Rural Anganwadi spent more time in all activities than urban Anganwadis(p<0.05) (Table.4). Most of the Urban Anganwadi workers are from same locality than Rural Anganwadi workers and the difference was statistically significant (p<0.05) (Table.5)

The education status of AWW of urban and rural AWC is depicted in figure 1 which shows there is significant difference(p=0.008) of level of education between them and 70% of urban AWW completed their metric level of schooling.

Discussion

Rural AWW are more experienced than Urban AWW(p<0.05). To avoid such differences, the existing training of AWWs to be evaluated and their continuous education should be strengthened. 90% of AWW in Urban AWC stays in same locality while 60% of AWW in Rural AWC are from distant locality(p=0.01) and they should be relocated to their own areas of residences to avoid problems of travelling. Rural AWW spent more time on job and other related activities than Urban AWW(p<0.05) and to enhance the performance, stringent and regular monitoring of AWC should be done by Health Workers, Supervisors, Medical Officers and CDPOs. Compared to Rural AWW, 70% of Urban AWW completed their metric level of schooling(p=0.008) Level of education influences on capability of understanding the difficult concepts.

Conclusion

Integrated child development services scheme is one of the vast national health programme India has seen till now. The focus area of the ICDS is nutrition to most vulnerable group such as Under 6 children, Pregnant and Lactating mother and Adolescent girls. The beneficiaries will be young generation of our country especially Under 6 children and Adolescent girls who are going to lead India to development. Currently, ICDS is named as Umbrella ICDS scheme which includes Anganwadi Services Scheme, Pradhan Mantri Matru Vandana Yojana, National Crèche Scheme, Scheme for Adolescent Girls, Child protection Scheme, POSHAN Abhiyaan. This will broaden the work of Anganawadi worker leading to need of extra training for newer concepts and time management for added work.

As per ICDS guidelines, the AWW should be recruited based on merit. The Job description of AWW includes supplementary feeding to beneficiaries, maintain health record, conducting Village Health and Nutrition day along with ASHA and ANM, conducting immunization sessions and regular health check-up, maintain various records, preschool education and numerous other functions. The level of education of AWW will have tremendous effect on the work management and understanding upcoming programmes.

The guidelines for functioning of AWW centres should be followed to maximize the service delivery such as time spent on activities like record maintaining, preschool education and supplementary feeding. The AWW from the same locality should be recruited as she will be familiar with the local people and it will decrease the problems of travelling for the AWW in unruly hours in case of emergencies.

Ethical approval: yes.

Funding Source: Nil.

Conflict of Interest: Nil.