|Year : 2014 | Volume
| Issue : 4 | Page : 468-472
Perceived responsibilities and operational difficulties of anganwadi workers at a coastal south Indian city
Monica Tripathy1, Sowmini P Kamath1, B Shantharam Baliga1, Animesh Jain2
1 Department of Pediatrics, Kasturba Medical College, Manipal University, Mangalore, India
2 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, India
|Date of Web Publication||25-Jun-2014|
Sowmini P Kamath
Department of Pediatrics, Kasturba Medical College, Light House Hill Road, Mangalore - 575 001, Karnataka
Source of Support: Indian Council of Medical Research, New Delhi under ICMR STS programme in 2010, Conflict of Interest: None
Context: Anganwadi worker (AWW) is an important functionary in integrated child development scheme (ICDS). Aim: To study perceived responsibilities, workload, operational difficulties, and satisfaction level of AWWs. Materials and Methods: Prospective observational cross-sectional study of 66 AWWs using a pre-designed proforma: Analysis using Statistical package for social sciences (SPSS) version 11.5. Results: Pre-school education, house visits, records-keeping were perceived as important activities by 92.4%, 60.6%, and 57.6%, respectively, growth monitoring and immunization by 3% and 4.5%, respectively; 51.5% did not have adequate time for duties, and 74.2% were doing non-ICDS duties. Heavy workload was the major perceived operational difficulty for 66.7% of the respondents. Timely supplementary food was available as per 92.4%. Inadequacies in equipments, workspace, training, and staffing were noted by 47%, 18.2%, 7.6%, 7.6%, respectively. No operational difficulties were seen by 10.6%. Induction job training was provided to 36 (54.5%), and 17/66 (25.8%) felt they were inadequately trained despite yearly refresher courses. Dissatisfaction with monthly honorarium, availability of equipment, supplementary food, and maintenance of registries was reported by 89.4%, 53%, 54.6%, and 43.9%, respectively. Despite this, 62.1% (40/66) were satisfied. Conclusions: Supplementary nutrition, growth monitoring, and immunization of children along with health education though being primary duties were given less emphasis. Heavy workload was the major perceived operational difficulty. Adequate staff, workspace, equipments, timely monthly honorarium should be provided along with training and avoidance of non-ICDS duties would help in achieving the objectives of ICDS.
Keywords: Anganwadi workers, ICDS, operational difficulties, perceived responsibilities
|How to cite this article:|
Tripathy M, Kamath SP, Baliga B S, Jain A. Perceived responsibilities and operational difficulties of anganwadi workers at a coastal south Indian city. Med J DY Patil Univ 2014;7:468-72
|How to cite this URL:|
Tripathy M, Kamath SP, Baliga B S, Jain A. Perceived responsibilities and operational difficulties of anganwadi workers at a coastal south Indian city. Med J DY Patil Univ [serial online] 2014 [cited 2022 Dec 2];7:468-72. Available from: https://www.mjdrdypu.org/text.asp?2014/7/4/468/135270
| Introduction|| |
Integrated child development scheme (ICDS) was set up in 1975 to combat malnutrition, anganwadi worker being its main functionary. India has 61 million stunted children, 50% being below age 5 with every second child under 6 years being underweight; a statistic worse than that in sub-Saharan Africa.  In spite of this program, there has been minimal change in the health status of children on comparing the results of two consecutive NFHS surveys (1998-99, 2005-06). 
We studied the perceived responsibilities, workload, and operational difficulties of anganwadi workers along with their level of satisfaction.
| Materials and Methods|| |
This cross-sectional study was conducted in Mangalore taluk, Dakshina Kannada, Karnataka, India over 2 months duration during July - August 2010. Assuming 75% awareness of responsibilities, for 95% confidence interval and with 15% relative precision, the minimum calculated sample size was 57. Expecting a non-response rate of 10%, the final sample size calculated was 65. The anganwadi workers of Mangalore were selected by non-random sampling (convenient sampling). The study was conducted after taking prior permission from the Zilla Panchayat, Mangalore. After obtaining informed consent from the anganwadi workers, data was collected using a questionnaire developed for this purpose. The questionnaire was translated into the local language Kannada and was translated back into English to ensure reliability and validity. The collected data were tabulated and analyzed using SPSS (Statistical Package for Social Sciences) version 11.5 for Windows. Chi-square test was used to test the association of education as well as other demographic factors with the satisfaction levels. The study was approved by the Institutional Ethics Committee of our institution.
| Results|| |
A total of 66 anganwadi workers answered the questionnaire. Majority (82%, 54/66) of the anganwadi workers were between 31-50 years of age, 93.9% (62/66) were married, 9%, (6/66) did not meet the criteria for the minimum education required for their job, and the rest 91% (60/66) were either matriculates, intermediates, or graduates. Travel distance was more than 5 kilometers for 9.1% (6/66). Majority of the AWWs (71.2%, 47/66) had more than 10 years of experience. While 71.2% (47/66) of the AWWs were motivated to work at anganwadis out of their own interest, a willingness to do social service or to be around with children; 15.2% (10/66) of them became anganwadi workers to combat their poverty.
When the anganwadi workers were asked to list the 3 most important duties they perform routinely, pre-school education, house visits/surveys, and record-keeping were perceived as the 3 most important activities by 92.4%, 60.6%, and 57.6%, respectively. These were also the tasks on which the maximum amount of time was spent varying between 5-15 hours/week [Table 1].
|Table 1: Hours per week spent by anganwadi workers on various routine activities|
Click here to view
Though growth-monitoring and immunization were one of the important set objectives of the ICDS to combat malnutrition and communicable diseases, it was perceived as important by only 3% and 4.5% of our respondents, respectively [Figure 1]. Providing supplementary food to anganwadi children, health education to women were perceived as important by 42.4% and 25.8%, respectively. Attending meetings related to progress of their anganwadi center functioning was perceived important by 13.6% AWWs.
The anganwadi centers function 6 days a week, and the mean numbers of hours the anganwadi workers work were found to be 6 hours per day. About half (51.5%, 34/66) of the anganwadi workers perceived that their duties could not be completed within their working hours. Three-fourth of them said that they had to work on Government holidays. Also, they were made to be involved in several non-ICDS programs that ranged from various health awareness campaigns (blood donation camps, malaria programs) to numerous surveys (ration card, election ID survey) and election duties. Over half (56.1%, 37/66) of them said these programs affected their routine activities at the anganwadi, and 74.2% (49/66) felt that they should be spared from participating in these programs.
Record-keeping and maintaining a register related to the set objectives of ICDS is mandatory in all anganwadi centers. In this study, it was noted that most of AWWs were unable to specify the correct number of registers that had to be maintained. There was no uniformity in the number of registers maintained, and the intervals in which they were filled also varied. Majority (92.4%, 61/66) of the anganwadi workers filled the registers on a daily basis; however, 7.6% (5/66) of them filled them only once a week.
Only 36 (54.5%) AWWs in this study had received one-month compulsory induction training (which oriented them to various aspects of mother and childcare, health, nutrition, and record-keeping) prior to being appointed. However, after becoming an anganwadi worker, 97% (64/66) of them received refresher courses once every 1-2 years. The content of induction training was reinforced in these refresher courses. One-third of them could not name the training that they had received. When questioned about the adequacy of training (induction training and refresher courses), 25.8% (17/66) of them felt that they were inadequately trained to suit their work requirements.
We asked the AWWs about the perceived operational difficulties that they faced during their day-to-day work. Two-third (66.7%) of AWWs felt that they were occupied and stressed with workload more than what is described in the ICDS project. They suggested that they should be spared from getting involved in non-ICDS programs.
Other issues expressed included difficulty in obtaining supplementary nutrition, transportation problems, inadequate workspace, staff, and training. Only 10.6% (7) of AWWs had no operational difficulties [Figure 2].
Level of satisfaction amongst the anganwadi workers regarding various aspects of their work
A majority (89.4%, 59/66) of anganwadi workers were dissatisfied with their wages provided. Nearly three-fourth (72.73%, 48/66) of anganwadi workers did not receive their monthly honorarium on time, and many a times, they received only half the amount. About 43.9% (29/66) of AWWs were found to be dissatisfied with the number of registers that had to be maintained. Nearly half the anganwadi workers opined that they were not provided with adequate equipments at the anganwadi center, and dissatisfaction with the quality of equipments was expressed by 35 (53%) AWWs. Adequate amount of supplementary food was provided on time in 92.4% (61/66) of anganwadi centers. However, most of anganwadi workers felt that quality of food provided was very poor, and dissatisfaction was expressed by 36 (54.6%) AWWs. Despite all these issues, 62.1% (40/66) AWWs were professionally satisfied. Most (86.3%, 57/66) of AWWs were found to be satisfied with response that they received from the community. A mixed response was obtained on the overall level of satisfaction. Over one-quarter of the anganwadi workers were found to be overall dissatisfied, another quarter satisfied, and the rest were neutral [Table 2].
There was a statistically significant association between the educational status and the level of satisfaction of the AWWs [Table 3]. There was no statistically significant association between education and financial satisfaction (P = 0.67) or professional satisfaction (P = 0.12).
|Table 3: Satisfaction of anganwadi workers according to education status|
Click here to view
| Discussion|| |
The ICDS was launched with the chief objective of breaking the vicious cycle of malnutrition, impaired development, morbidity, and mortality in young children. As the anganwadi workers are the backbone of the ICDS, the success of the program depends on the extent to which they can deliver their services. Providing immunization, supplementary nutrition, health check-up, referral services, pre-school non-formal education, nutrition, and health education are their primary duties to achieve the ICDS objectives. The study revealed that among the important perceived responsibilities of anganwadi workers, activities such as pre-school education, house visits/ surveys, and record-keeping got the highest priority. Providing supplementary nutrition and health education were given relatively less emphasis. It is appalling to note that immunization, monitoring growth of children, and health checkups were not perceived as important by most of the AWWs surveyed. Consequently, least amount of time was spent on above-mentioned activities. If they do not perceive these duties as important, they are more likely to neglect the important activities and defeat the objectives of ICDS program.
Thirty-five years after its implementation, ICDS has produced results below expectations. One of the reasons is possibly due to a misperception of responsibilities by anganwadi workers with primary focus moving away from health and nutrition education towards pre-school education and record-keeping. Even though pre-school education is an important activity, and was perceived adequately, this was not only the priority aim with which the ICDS program was initiated.
Similar findings were observed in a study done by Dongre et al. where AWWs' workload was due to record-keeping, thereby neglecting their primary functions.  As stated by Ghosh,  the prime responsibility of the anganwadi worker must be health and nutritional education.
The results showed that 45.5% of AWWs were not given any induction training. However, 97% of them did receive some training sometime after appointment. Inspite of the trainings, 25.8% felt that they were not trained sufficiently to suit their job requirements. It indicates that there is a need for more frequent on the job trainings and refresher courses at regular intervals. This has been endorsed by other researchers as well. ,,
The number of registers maintained in the anganwadis was not uniform, and knowledge regarding registers was found to be poor, though record-keeping was found to be an importantly perceived activity in our study.
There have been extremes of observation in different studies with regards to the knowledge of anganwadi workers. In a study by Lalit Kant, none of the anganwadi workers could enumerate correctly all her job responsibilities.  On the other hand, Umesh Kapil found that knowledge, attitude, and practice of AWWs with respect to growth-monitoring, supplementary nutrition, and immunization were adequate. 
As per our study, the major operational difficulty faced by the anganwadi workers was found to be their workload due to their multiple responsibilities. Anganwadi workers were also found to be involved in several non-ICDS program, compounding to already existing workload in the anganwadis. Over two-third of Anganwadi workers found it difficult to meet all the demands of their work. Their chief complaint was their low wages. The monthly honorarium was not given to the anganwadi workers on time, and many a times, only half the amount would be paid. For 15.2% (10/66) of AWWs who were motivated to work due to poverty, this would be a major discouraging factor. Majority of the AWWs were financially dissatisfied and would definitely reduce the performance. Further, about a quarter complained about difficulty in obtaining supplementary nutrition. The rest faced difficulties due to insufficient workspace, inadequate knowledge, and inadequate staff.
This study found that there were misperceptions about some of the duties among the anganwadi workers surveyed. They also had several operational difficulties and were dissatisfied with certain issues including wages. Thus, to conclude, it is recommended that timely and adequate remuneration of anganwadi workers should be ensured, and their workload should also be reviewed and simplified. Further, anganwadi workers should not be recruited for non-ICDS duties and their official job description should be adhered to in order to achieve the desired targets of the ICDS program.
| Acknowledgement|| |
We acknowledge Mr. M. S. Kotian for his assistance and guidance in carrying out statistical analysis.
| References|| |
|1.||Most of world's stunted children live in India, says Lancet. Indian Express. 2008 Jan 28. Available from: http://southasia.oneworld.net/Article/most-of-world2019s-stunted-children-live-in-india-says-lancet [Last accessed on 2012 Oct 24]. |
|2.||Arnold F, Parasuraman S, Arokiasamy P, Kothari M. Nutrition in India.National Family Health Survey (NFHS-3), India, 2005-06. Mumbai: International Institutefor Population Sciences; Calverton, Maryland, USA: ICF Macro; 2009. p.13. |
|3.||Dongre AR, Deshmukh PR, Garg BS. Perceived responsibilities of Anganwadi Workers and Malnutrition in Rural Wardha. Online J Health Allied Scs 2008;7:3. Available at: http://openmed.nic.in/2867/01/2008-1-3.pdf [Last accessed 2014 June 13]. |
|4.||Ghosh S. Child malnutrition. Economic and Political Weekly (Online). Vol 39, no 40. Available from:http://www.epw.org.in [Last accessed on 2004 Oct 02]. |
|5.||Kant L, Gupta A, Mehta SP. Profile of anganwadi workers and their knowledge about ICDS. Indian J Pediatr 1984;51:401-2. |
|6.||Chattopadhyay D. Knowledge and skills of Anganwadi workers in Hoogly District, West Bengal. Indian J Community Med 2004;29:117-8. |
|7.||Udnani RH, Chothani S, Arora S, Kulkarni CS. Evaluation of knowledge and efficiency of Anganwadi workers. Indian J Pediatr 1980;47:289-92. |
|8.|| Kapil U, Tandon BN. ICDS scheme-current status, monitoring, research and evaluation system. Indian J Public Health 1990;34:41-7. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]