Workload and perceived constraints of Anganwadi workers

Workload and perceived constraints of Anganwadi workers Damanpreet Kaur, Manjula Thakur, Amarjeet Singh, Sushma Kumari Saini Abstract : Integrated Child Development Service scheme is most important nutritional programme in the field of child welfare. Its effectiveness depends upon the efficiency of its functionaries at grass root level i.e. Anganwadi workers. This cross sectional exploratory study was conducted to assess the workload and perceived constraints of Anganwadi workers in a north Indian city. Convenient sampling was used to select sample of fourteen Anganwadi centres and Anganwadi workers. Total 2 observations were carried out at 1 Anganwadi centres and observation record sheet was used to record the activities performed and time consumed. In-depth interview guide was used to identify the perceived constraints with 10 Anganwadi workers in carrying out their duties. Descriptive (percentage, mean and standard deviation) and inferential statistics (one sample t test and independent t test) was used for analysis. Anganwadi workers was not able to work as per the activities specified in recommended time as records maintenance consumed lot of time i.e. three times more than the recommended time. Due to this, time spent in preschool education and home visit was less than the recommended time. Low honorarium, register work, meeting out of duty hours, short attendance of children and adolescent girls, not adequate space in Anganwadi centre, no government building for Anganwadi centre were some of the problems reported by Anganwadi workers. Anganwadi workers were unable to render services as per the recommended time because considerable time was spent in maintaining records and other activities. So, time allocation pattern for ICDS activities need to be reviewed. Keywords Anganwadi worker, workload, perceived constraints Correspondence at Damanpreet Kaur Sister Grade II PGIMER, Chandigarh Introduction Children are the first call on the agenda of human resource development of every nation, not only because young children are the most vulnerable, but because the foundation for lifelong learning and human development is laid in these crucial, early years. Various projects and schemes have been run by the Indian government in order to raise the health status of children and mothers since independence eg. Balwadi Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 18

nutrition programme, special nutrition programme, applied nutrition programme. But in 1972, inter ministerial survey revealed that none of the programme was having the desired impact due to resource constraints, inadequate coverage, and a fragmented approach. Moreover the maternal mortality and infant mortality rates were high in the country due to drought in 1975. So, keeping all these issues in view a new progmramme ICDS was launched on 2nd October, 1975 during the 5th five year 1 plan in pursuance of national policy. Integrated child development scheme is one of the largest programmes launched on children nutrition. ICDS is a centrally sponsored programme implemented by the Department of Women and Child development and Ministry of Human Resource Development of the government of India. The ICDS services are delivered by an honorary worker i.e. Anganwadi worker. Anganwadi Worker is a community based frontline honorary worker of the ICDS Programme selected from the local community. National Institute of Public Cooperation and Child Development (NIPCCD) had recommended time distribution of various activities to be performed by Anganwadi. Main activities of anganwadi worker included supplementary nutrition, preschool education, immunization, health check-ups and referral services. With time Anganwadi worker was expected to do the additional jobs. Since attainment of ICDS goals depends heavily upon the effectiveness of anganwadi workers, on the other hand performing and discharging many duties in a limited time leads to stress and discontent among the 2 AWWs. Previous research studies have reported that Anganwadi worker were rather overloaded with work which affected their performance. So workload of anganwadi worker has been under scrutiny. Against this background, the present study was undertaken with an objective to assess the workload and perceived constraints of anganwadi workers. Methods A cross sectional exploratory study was undertaken to assess the workload and perceived constraints of Anganwadi workers in selected Anganwadi centres of a north Indian City. Supervisor of the respective Anganwadi centre was informed. Convenient sampling was used to select the Anganwadi centres for time and distance constraints. Fourteen Anganwadi centres and Anganwadi workers were chosen conveniently. Tools used for data collection were observation record sheet to record the activities performed by Anganwadi workers, in- depth interview guide to identify the perceived constraints by Anganwadi workers. So observation and interview were the techniques used for data collection. Tools were developed after reviewing relevant literature and validated by experts from nursing and Community medicine, PGIMER, Chandigarh. The data was collected during the month of August and September 2013.Written consent was taken from Anganwadi workers prior to data collection. The data was collected on all the working days of week i.e. from Monday to Saturday. During observation, the activities performed by Anganwadi worker to deliver the ICDS services and the time consumed for each activity was recorded. Total 2 observations were recorded. In depth interviews were conducted with 10 Anganwadi workers based on in depth interview guide for anganwadi worker to identify the perceived constraints as after 10 indepth interviews, the responses were similar. The collected data was analyzed using descriptive (percentage, mean and Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 19

standard deviation) and inferential statistics Results (one sample t test and independent t test). Out of total recommended time by NIPCCD Calculations were done with the help of (National Institute Of Public Cooperation SPSS v.16.0 program. And Child Development) i.e. 270 minutes per day, on an average anganwadi worker spent Table 1: Mean time spent by AWW against recommended time per activity per day in all the AWCs (N=306) Activity recommended Recommended Mean time Mean % t, df, p by NIPPCD time (min.) per spent spent NIPCCD (%) (minutes) time 1. Preschool education 120(.) 28.12±30.79 10 1.61,23,0.001 2. Supplementary nutrition 30(11.1) 28.6±13.5 10 0.558,23,0.583 3. Treatment of minor illness* 30(11.1) - - -. Records 30(11.1) 83.0±7.9 31 5.20,23,0.001 5. Home visit 60(22.2) 6.82±13.8 3 18.9,22,0.001 Total (recommended 270 15.88±58.3 5 10.3,23,0.001 activities) Other activities** - 70.33±30.21 26 Unspecified work*** - 53.79±51.30 20 Grand total 270 270.56 - #One sample t test applied *no case was reported during the observation period ** health education to beneficiaries,listening to their problems,meeting with ANM,MO,training at CHC,pulse polio duty,talking with other AWW on clarification of doubts,visiting other AWC *** unspecified work include tea time, coming late to AWW, going early from centre, going out for personal work 83.0±7.9 minutes in maintaining records against recommended time of 30 minutes (p < 0.001) (table 1). In supplementary nutrition almost same time was devoted which was recommended i.e. 30 minutes. Mean time spent in preschool education in all the Anganwadi centre was 28.12± 30.79 minutes against the recommended time of 120 minutes (p < 0.001). Mean time spent on home visit was only 6.082±13.8 minutes against the recommended time of 60 minutes (p < 0.001). Time spent on the specified activities by NIPCCD was only 5% while 26 % of time was spent on other activities, which included health education to beneficiaries, listening to their problem, meeting with ANM, MO, Training at CHC, Pulse Polio duty, talking with other AWW on clarification of doubts and visiting other Anganwadi centres. Some (20%) of total time was spent by Anganwadi workers in unspecified work i.e. personal work. (Table 1 & Fig 1) Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 20

Fig 1 : Mean percent time spent on different activities by anganwadi worker in respect to total available time on different activities in all the AWCs 20% specified activities 26% 5% other activities unspecified work Ten Anganwadi workers were interviewed for perceived constraints and their mean age was 35.7 ± 6.05 years. Six of the Anganwadi worker had studied up to 10+2 whereas one of them was also graduated. Half of the Anganwadi worker had working experience of 16-20 years and the mean working experience was 11 ± 7. 0 years. All of them were trained. Only four of them were residing in the same area.one fourth of Anganwadi worker had their residence at distance of less than 1 km from Anganwadi centre. Six of them were working in urban Anganwadi centre. Seven of Anganwadi worker were running Anganwadi centre in rented buildings. Low honorarium, more register work, meeting out of duty hours, short attendance of children and adolescent girls, not adequate space in Anganwadi centre, no help from community leaders, no seasonal vacations, no government building for Anganwadi centre were the main problems reported by Anganwadi workers. Discussion Now days the role of Anganwadi Worker is not limited to the basic ICDS programme activity. Presently, the AWWs also have to be involved in the Pulse Polio Immunization programme and disease control programs, election duties that require door to door visits beyond the working hours, which further stress them. They are also the member of Mahila Mandal and Village Health and sanitation committee in some states. As she has to perform a no. of responsibilities within the restricted working hours, so quality of services provided is affected within the limited time. NIPCCD has given the recommended time for carrying out different activities of ICDS. Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 21

It was found in the present study that Anganwadi worker was not able to devote the recommended 270 minutes per day on 3 the activities recommended by NIPCCD. Time spent on recommended activities was only 5% of the total time spent per day (fig 1). Moreover, the time spent on recommended activities was not proportionate i.e. prioritization of activities was wrong. Records maintenance consumed a lot of time i.e. three times more than the recommended time. Due to this, time spent in preschool education and home visit was less than the recommended time (fig 2). The present study revealed that the time spent on preschool education was 28.12 minutes which was only 23% of the recommended time to be spent on preschool education. The time spent on preschool education was less than the recommended time because rest of the time was spent on records maintenance by Anganwadi worker, in dealing with beneficiaries, filling up forms, clarifying beneficiaries' doubts on schemes. The findings of the present study were similar to a study conducted in Orissa by Ray in which time spent on preschool education was 20 minutes. A survey in 28 states in 2009 showed that time spent on preschool education was 89 minutes which was also 5 less than the recommended time. Whereas different findings were reported in a study conducted by Pandey in 2008 in four states showed that overall 10% of the anganwadi worker were spending 3 hour on preschool education activities which was one and a half times more than the recommended 6 time. The recommended time for supplementary nutrition is 30 minutes per day by NIPCCD and the present study showed that the time spent on supplementary nutrition was 28.6 minutes per day which is 95% of the recommended time to be spent on it which showed that time allocated for supplementary nutrition was adequate. But Ray (1990) reported that 10 minutes were utilized for supplementary nutrition in a study conducted in Orissa. The time spent on supplementary nutrition in the former studies was within the recommended time because cooked food was supplied and only distribution and feeding was done at the Anganwadi centre. Whereas more than the recommended time was spent in Anganwadi centre where food was cooked at the Anganwadi centre and distributed as shown in the following studies. A survey in 28 states showed that time spent on supplementary nutrition was 5 51 minutes. A study conducted by Phillips and Kurian in 1986 in Madhya Pradesh revealed that time spent on supplementary nutrition was 120 minutes which is almost four times the recommended time for supplementary nutrition. The time spent was appropriate because food for supplementary nutrition was prepared at the Anganwadi centre. Another study by Rane and Narayan in 1989 had shown that 180 minutes were spent in supplementary 2 nutrition. Pandey in 2008 conducted a study in four states showed that out of total 57% of the Anganwadi worker were spending less than one hour on 6 supplementary nutrition. The recommended time for home visit by NIPCCD is 60 minutes. It was found in the present study that the mean time spent by Anganwadi worker was 6.82 minutes per day which was 11% of the recommended time for home visit. Whereas in another study in 1989 by Rane and Narayan had shown that time spent in home visit was 60 minutes which was equal to the 5 recommended time. The major problems Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 22

faced by Anganwadi workers were that women beneficiaries went out for work the whole day and hence could not be contacted and some of the women were hostile towards Anganwadi workers in sansi community and did not respond at all. The recommended time by NIPCCD for record maintenance is 30 minutes. Whereas present study showed that Anganwadi worker spent 83.0 minutes per day on records which was almost three times the recommended time.they focused more on maintaining records because their records were evaluated by the supervisors, CDPO (Child Development Project Officer), PO (Project Officer) and other inspecting teams and reflects their performance. Whereas in another study conducted by Ray in 1990 in Orissa showed that 100 minutes were utilized for maintaining records. Even a survey in 2009 in 28 states showed similar results i.e. 99 minutes were spent by Anganwadi worker in maintaining records whereas in study conducted by Rane and Narayan in 1989 had shown that time spent in maintaining records was 60 minutes. All the studies had shown that more than the recommended time was spent in maintaining records. Concerning this issue, new comprehensive registers were designed by Ministry of Women and Child Development. This scheme had been implemented in some of the states. Anganwadi worker has to health educate beneficiaries, listen to their problems, meet with ANM (Auxiliary Nurse And Midwife), MO (Medical Officer), attend training at CHC (Community Health Centre), pulse polio duty, discuss with other Anganwadi workers on clarification of doubts, visit other Anganwadi centre. These all were the activities those were related to health aspect indirectly for which there is no specification of time in total recommended time of 270 minutes per day by NIPCCD. The time spent on other activities was 70.33 minutes per day which accounts for 26% of the total time spent (fig 1). So, Anganwadi worker were unable to devote time to other important activities such as preschool education. Since they were supposed to spend 270 minutes for the specified activities, but it was found in the present study it was only 15.88 minutes. Rest of the time was spent on unspecified work which includes tea time, coming late to Anganwadi centre, going early from centre; going out for personal work was 53.79 minutes which accounts for 20% of the total time they are spending per day (fig 1). Some of these activities such as tea time, talking to helper on general issues are need of a human being for which no time is mentioned in the recommended time. Whereas in all other work settings, employees have separate time for tea and lunch. But for Anganwadi workers no such timings have been specified. In the present study, only four Anganwadi workers were residing in the same area within one Km distance from Anganwadi centre whereas rests were from outside the area. This should be 100% and should be kept in mind at the time of selection process. In a study by Desai and others found almost 87% Anganwadi workers were from same village where 7 the Anganwadi is located. It was found in the present study that seven Anganwadi workers were running Anganwadi centre in rented building and even two of the Anganwadi centre were situated on the second floor which was not convenient especially for the children and pregnant mothers as far as safety is concerned. Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 23

Problems reported by Anganwadi workers in the present study were of low honorarium, too much register work, meeting out of duty hours, short attendance of children and adolescent girls, not adequate space in Anganwadi centre, no help from community leaders, no seasonal vacations, no government building for Anganwadi centre. Out of the reported problems two similar problems of absenteeism of children, problems in getting low honorarium were faced by Anganwadi workers in a study conducted in Manglore and others were of bringing food from the office of social welfare office, problems in working with higher authorities in a study conducted by Maggie and [] D'Souza in 1989. In a study by Thakare and others, 75% of the workers complained of inadequate honorarium, complained of lack of help from community and other problems reported were infrastructure related supply, excessive work overload and 8 record maintenance. Conclusion It can be concluded that Anganwadi workers were burdened with records and devoted considerable time in maintaining records and other activities and they faced lots of problems in carrying out their job. To address all these issues, time allocation pattern for ICDS activities need to be reviewed and separate time for meetings and other activities should be allocated other than 270 minutes so that workload on Anganwadi workers can reduce and they can function effectively. Acknowledgements We are thankful to the social welfare department, Chandigarh and the Anganwadi workers. References 1. Rowe A, Savigny D, Lanata C. How can we achieve and maintain a high-quality performance of the health workers in low-resource settings? Lancet 2005; 366:1026-35 2. Gupta A, Gupta S, Nongkynrih B. Integrated Child Development Services (ICDS) Scheme: A Journey of 37 years. Indian Journal of Community Health (IJCH) 2013; 25 (1): 77-81 3. National institute of public cooperation and child development. (2006). Handbook for Anganwadi workers. Retrieved February 10, 2015 from: http://nipccd.nic.in/syllabi/eaw.pdf.. National institute of public cooperation and child development. Research on ICDS An Overview Volume 2; 2009. Retrieved February 11, 2015 from: URL: http://nipccd.nic.in/reports/icdsvol2.pdf. 5. Programme evaluation organization, planning commission. Govt. of India. (2011). Evaluation report on the integrated child development services.(peo report no. 218) Retrieved February 0 5, 2 0 1 5 f r o m : http://www.planningcommission.nic.in/reports/pe oreport/peoevalu/peo_icds_v1.pdf 6. National institute of public cooperation and child development. (2010) Research abstracts on ICDS. Retrieved February 11, 2015 from: http://nipccd.nic.in/reports/icdsvol3.pdf. 7. Desai G, Pandit N, Sharma D.(2012) Changing role of Anganwadi workers, A study conducted in Vadodara district. Journal of Indian Association of Preventive and Social Medicine 2012, 3 (1), 1-. 8. Thakare MM, Kurll BM, Doibale MK, Goel NK. Knowlegde of Anganwadi workers and their problems in an urban ICDS block. Journal of Medical College Chandigarh 2011, 1(1),15-21. Nursing and Midwifery Research Journal, Vol-12, No. 1, January 2016 2