India is home to the largest population of malnourished and hunger-stricken people and children leading to high infant and maternal mortality. Along with these issues are a deluge of problems ranging from diseases, lack of education, lack of hygiene, illness, etc.
To combat this situation, the Government of India in 1975 initiated the Integrated Child Development Service (ICDS) scheme which operates at the state level to address the health issues of small children, all over the country. It is one of the largest child care programmes in the world aiming at child health, hunger, mal nutrition and its related issues.
Under the ICDS scheme, one trained person is allotted to a population of 1000, to bridge the gap between the person and organized healthcare, and to focus on the health and educational needs of children aged 0-6 years. This person is the Anganwadi worker.
What does Anganwadi mean?
The name anganwadi worker is derived from the Indian word – angan, which means the court yard (an central area in and around the house where most of the social activities of the household takes place). In rural settings, the angan is the open place where people gather to talk, greet the guests, and socialize. Traditional rural households have a small hut or house with a boundary around the house which houses their charpoys, cattle, feed, bicycle, etc. Sometimes food is also prepared in the angan. Some members of the household also sleep outside in open air, under the sky, in their angans. The angan is also considered as the ‘heart of the house’ and a sacred place which buzzes with activity at the break of dawn. Given the nature of this versatile nature of this space, the public health worker who works in an angan, and also visits other people’s angans, helping with their healthcare issues and concerns, is the Anganwadi worker.
The Anganwadi worker and helper are the basic functionaries of the ICDS who run the anganwadi centre and implement the ICDS scheme in coordination with the functionaries of the health, education, rural development and other departments. Their services also include the health and nutrition of pregnant women, nursing mothers, and adolescent girls.
Today in India, about 2 million aanganwadi workers are reaching out to a population of 70 million women, children and sick people, helping them become and stay healthy. Anganwadi workers are the most important and oft-ignored essential link of Indian healthcare.
Anganwadi workers are India’s primary tool against the menace of child malnourishment, infant mortality, and lack of child education, community health problems and in curbing preventable diseases. They provide services to villagers, poor families and sick people across the country helping them access healthcare services, immunization, healthy food, hygiene, and provide healthy learning environment for infants, toddlers and children.
Anganwadi workers are key informants of healthcare issues but given the nature of their work, they are also being called as social workers and many more activities are being added to their job profile, such as the kind of services they provide in Dindigul.
What do the Anganwadi Workers do?
The Anganwadis are engaged to provide the following formal services to the areas under their cover:
- Immunisation of all children less than 6 years of age
- Immunisation against tetanus for all the expectant mothers
- Supplementary nutrition to children below 6 years of age
- Supplementary nutrition to women who are pregnant and nursing, esp. from the low income group
- Nutrition, health education and health check-ups to all women in the age group of 15- 45 years
- Antenatal care of expectant mothers
- Postnatal care of nursing mothers
- Caring for newborn babies
- Caring for all children under 6 years of age
- Referral of serious cases of malnutrition or illness to hospitals, upgraded PHCs/ Community Health Services or district hospitals
- Non-formal preschool education to children of 3-5 years of age.
Role and responsibilities of AWWs
According to the The Ministry of Women and Child Development - The Government of India, the following are the basic roles and responsibilities listed for the anganwadi worker:
- To elicit community support and participation in running the programme.
- To weigh each child every month, record the weight graphically on the growth card, use referral card for referring cases of mothers/children to the sub-centres/PHC etc., and maintain child cards for children below 6 years and produce these cards before visiting medical and para-medical personnel.
- To carry out a quick survey of all the families, especially mothers and children in those families in their respective area of work once in a year.
- To organise non-formal pre-school activities in the anganwadi of children in the age group 3-6 years of age and to help in designing and making of toys and play equipment of indigenous origin for use in anganwadi.
- To organise supplementary nutrition feeding for children (0-6 years) and expectant and nursing mothers by planning the menu based on locally available food and local recipes.
- To provide health and nutrition education and counseling on breastfeeding/ Infant & young feeding practices to mothers. Anganwadi Workers, being close to the local community, can motivate married women to adopt family planning/birth control measures
- AWWs shall share the information relating to births that took place during the month with the Panchayat Secretary/Gram Sabha Sewak/ANM whoever has been notified as Registrar/Sub Registrar of Births & Deaths in her village.
- To make home visits for educating parents to enable mothers to plan an effective role in the child’s growth and development with special emphasis on new born child.
- To maintain files and records as prescribed.
- To assist the PHC staff in the implementation of health component of the programme viz. immunisation, health check-up, ante natal and post natal check etc.
- To assist ANM in the administration of IFA and Vitamin A by keeping stock of the two medicines in the Centre without maintaining stock register as it would add to her administrative work which would effect her main functions under the Scheme.
- To share information collected under ICDS Scheme with the ANM. However, ANM will not solely rely upon the information obtained from the records of AWW.
- To bring to the notice of the Supervisors/ CDPO any development in the village which requires their attention and intervention, particularly in regard to the work of the coordinating arrangements with different departments.
- To maintain liaison with other institutions (Mahila Mandals) and involve lady school teachers and girls of the primary/middle schools in the village which have relevance to her functions.
- To guide Accredited Social Health Activists (ASHA) engaged under National Rural Health Mission in the delivery of health care services and maintenance of records under the ICDS Scheme.
- To assist in implementation of Kishori Shakti Yojana (KSY) and motivate and educate the adolescent girls and their parents and community in general by organzing social awareness programmes/ campaigns etc.
- AWW would also assist in implementation of Nutrition Programme for Adolescent Girls (NPAG) as per the guidelines of the Scheme and maintain such record as prescribed under the NPAG.
- Anganwadi Worker can function as depot holder for RCH Kit/ contraceptives and disposable delivery kits. However, actual distribution of delivery kits or administration of drugs, other than OTC (Over the Counter) drugs would actually be carried out by the ANM or ASHA as decided by the Ministry of Health & Family Welfare.
- To identify the disability among children during her home visits and refer the case immediately to the nearest PHC or District Disability Rehabilitation Centre.
- To support in organizing Pulse Polio Immunization (PPI) drives.
- To inform the ANM in case of emergency cases like diahorrea, cholera etc.?
How does the Anganwadi System Work?
The Anganwadi system in one village/ area is managed by a single Anganwadi worker, who is chosen from the community and has been trained for four months in areas such as health, nutrition and childcare. Each Anganwadi worker covers a population of about 1000 people.
It is heartening to know that there more than a million Anganwadi centers in India, employing more than 2 million workers, who are mostly female and intuitive to the health needs of the region. For a country where illness, child mortality, illiteracy and poverty co-exist, this comes as a refreshing statistic.
MukhyaSevika – The Supervisor of Anganwadi Workers
For every 10 Anganwadi workers, there is an Anganwadi Supervisor to provide on-the-job guidance, who is also known as Mukhya Sevika. Apart from the healthcare, nutrition and educational work, the following are the responsibilities of the Anganwadi Supervisor:
- Checks the list of beneficiaries from the low economic strata, who are severely malnourished,
- Guides AWWs in the assessment of correct ages of children, correct method of weighing the children, and plotting their weights on growth charts,
- Demonstrates to the AWWs the effective methods of providing health and nutrition education to mothers, and
Maintains the statistics of the Anganawadis
The Mukhya Sevikas, in turn, report to the Child Development Projects officer (CDPO)
How does the Anganwadi System help?
India is home to over-population, mal nutrition, poverty, unemployment, low literacy levels and more, with a target to make healthcare accessible and affordable for everyone. Given the urgency of healthcare issues, child mortality, mal nutrition, etc., our country needs high number of medical and healthcare professionals to cater to the population that is now running into billions. Faced with acute shortage of skilled professionals, the Government’s ICDS scheme is using the local population to help meet its grand goals.
The Anganwadi worker hails from the village where she works and has her finger on the pulse of the health of the village, its people and children.
Apart for the healthcare knowledge that she possesses and gained over a period of time, the Anganwadi worker is so entrenched in the general affairs of the household that she is in a better position to understand the real malady behind the healthcare issues. These latent problems of the household or community could range from relationship issues, daily hassles, sanitation, nutrition, social, peer pressure, and much more. Given the definition of health – the physical, metal, social, spiritual wellbeing of an individual, the Anganwadi worker perhaps has the best insight into the people’s health of her region.
While educated doctors, learned nurses and seasoned professionals are excellent in their work and skills, they mostly lack the social skills and expertise which is more than necessary in interacting with the rural folk. An anganwadi worker is well versed in the ways of the village, knows the people by their names, interacts with them on regular basis and may also has an personal relationship with the people.
Anganwadi workers need to have good communication skills. They are usually adept in using the right language, metaphors and allusions for convincing people to act in a certain way. Religious customs and sentiments work best for them.
Here is an interesting account of how the Anganwadi worker convinced the villagers from defecating on open land. From shaming the defecators, convincing the women of the house, to citing the sacred texts that emphasized cleanliness and took the sanitary hygiene of the village to much higher level than one can imagine. Such is the power of the Anganwadi worker.
Some Anganwadi workers are very enterprising. Like the ones in Tamil Nadu, trhey have taken the initiative of growing kitchen gardens to help meet the nutritional needs and achieve the objectives of reducing mal nutrition of 0-6 year olds. So far 200 kitchen garden initiatives have been undertaken where Anganwadi workers will be trained in laying the gardens and growing crops, on one cent of land allotted to them. …
With minimum qualification to boot, an Anganwadi worker is deemed wise in the ways of the village and in the duties that she performs. Their understanding, communication skills and approach is needed to implement the grand projects of the state and central Governments, making them the most vital link in delivering the ‘health for all’ mission.