Recognising anganwadi workers as government employees will empower them and motivate them to work better
The Union Government's National Policy for Children acknowledged the dire needs of children way back in 1974. The result was the formulation of Integrated Child Development Services (ICDS) scheme in 1975 for holistic care of children of 0-6 years of age. Over 30 years into this national scheme, still a majority of our children continue to stay undernourished and uncared for. Who should be held responsible?
Statistics-wise almost half our children of age less than three years are underweight and about 80 per cent in the same age group are anaemic as per the third National Family Health Survey (NFHS) from 2005 to 2006.
The number of 'wasted' children who are too thin for height has increased from 16 per cent in 1990s to 19 per cent by the time of the last NFHS survey. Even if you look at under-nutrition statistics for children under five years at an international level, India stands at 48 per cent, much higher than Ethiopia (39 per cent) or Malawi (22 per cent)!
The ICDS scheme envisions simultaneous provisioning of health, nutrition and pre-school education for children below six years of age while also caring for nutrition and health education needs of pregnant, lactating mothers, and more recently, for an additional category of adolescent girls under the Kishori Shakti Yojana.
The original conceptualisation of ICDS was to run it as a long-term community-based programme, sustained by members of the community, especially women who benefit from this novel scheme. It gets operationalised through local Anganwadi Centres (AWCs), each with one part-time Anganwadi Worker (AWW) and a helper to carry out multiple tasks and record details of each task in registers daily. Though all the backbreaking work is part of their job profile, yet they're not recognised as government employees who get some facilities if not many.
However, higher level officials like supervisors or Child Development Project Officers (CDPOs) are recognised as government employees whose role is to make sure that 'work gets done' at the ground level. We can safely say that they ensure that registers get filled up with nutrition and health-related data by AWWs, whose accuracy or methodology of collection is not anyone's concern.
"When I first became an AWW in 1988, the ICDS system was much more effective than what it has become now," said Parvati (name changed). She works as an AWW in one of the anganwadis in Dakshinpuri, Delhi.
The main work of an AWW is to provide nutrition to small children, provide them pre-school education, record and refer cases of malnourished or ill children, pregnant or lactating mothers to the nearby medical facility, provide health and nutrition education to expecting mothers and adolescent girls, perform surveys related to mortality, pregnancy and ill-health in the community, cooperate with the Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) during immunisation drives, help them in other health related work etc, since she is well-known in the community and has all the data the government needs to run any of its programmes.
"Can you imagine this kind of workload on me and my helper, daily, even though we are supposedly part-time 'social workers' getting an honorarium for our services? We get no recognition for the worth of our work, no old-age benefits or security, not even minimum wages, but the blame is entirely ours when anything goes amiss. For instance, when food served at the anganwadi turns out to be of poor quality, we're held by the neck by everyone, including the media. But we don't cook the food here anymore like we used to earlier, so how can we be held responsible for its quality?" she asked desperately.
Showing the rusted and unsteady weighing machine she still uses to record weights of children - this is how levels of malnutrition are calculated - she admitted, "I know this machine cannot weigh correctly, still, I use it because I cannot afford to purchase a new one myself. Obviously the data calculated from readings I record in registers is fudged and won't show the real picture regarding health of people in the community. But I cannot help it as no one listens to me when I demand more facilities for children here."
"The government doesn't give us money for paying timely rent for the AWC, which is mostly a room in the house of the AWW, with no colourful charts or educational material, not even a silly board to identify the room as an AWC! We cannot hire a room for the measly amount of Rs 750 per month given by the government. Our own salary is no more than Rs 1,500 per month, and sometimes we get it only after six months. Who can work for the government like this forever?" she questioned.
"Some of us pay AWC rent from our own pockets and even for the data entry registers. Often, I end up entering government data in my children's notebooks since the registers and stationery given to us is inadequate," lamented Parvati.
In the 1980s, however, the scenario was drastically different. "We used to get paid on time even though the amount was a lot less than our current pay. There used to be timely provisioning of materials required for running the anganwadi. We got everything from phenyl, weighing machines, registers and utensils to pre-school education material for children like clay, wooden toys, colourful fruit and vegetable charts, drawing sheets, crayons, storage cupboards etc. That is how we could achieve at least some of the AWC's goals," she reminisced.
"Then, children used to spend quality time with us, learning and developing skills while also getting nutritious, freshly made food at regular intervals. Unlike today, we used to get raw food and the helper used to cook for the children on a daily basis. Today, the prepared food comes from somewhere far, perhaps from an NGO that has a private contract with the government. We don't know how stale or hygienic this food is, what quality of food material was used during preparation etc. We even had people complaining about cockroaches and worms till recently. Everyone avoids having this food anyway because it is neither tasty nor nutritious," she rued, fearfully exposing the current situation of her AWC in Dakshinpuri.
"Yahan poshan nahin shoshan ho raha hai. Netalog humare naam pe khub paisa kama rahe hain (There is no nutrition being given here, only misuse and exploitation of resources in the name of government schemes in which leaders end up making lots of money). Hummain kya milta hai yahan, sirf logon ka gussa (What do we get here, only public anger)?"
This situation is not unique to Delhi. "In terms of infrastructural provisioning, about 40 per cent of the AWCs in India still run under thatched roofs, huts or under trees instead of pucca government buildings. If the government cares for its children, it has to provide at least a decent roof over their head," said Kandikuppa Hemlata, general secretary of the All India Federation of Anganwadi Workers and Helpers in an interview with Hardnews.
"By the end of 2007, only 6.29 crore of the eligible 16.6 crore children were being covered by the ICDS," said Hemlata while explaining the rationale behind the Supreme Court's order to universalise the spread of anganwadis to every human habitation in India so that children and mothers, especially those who are poor and from the marginalised communities, can claim their right to food. This would lead to building more anganwadis to connect with more people and provide them with basic nutrition and health facilities.
Priya John, senior programme manager at the ICICI Centre for Child Health and Nutrition, said, "In Sunderpahari block, Godda district of Jharkhand, the AWW is usually more disempowered as is the case with most AWWs of north India when compared to those of south India."
"You can at least think of AWWs mobilising women in Delhi, but in the most backward interiors of the country, where households are also separated by vast distances, it is difficult to do any community activity with prejudices against AWW women, who are also tribal, playing out. Besides, the level of apathy and corruption among those administering the ICDS is very high, with probably everyone bribing everyone in a top-bottom chain." Even though the anganwadi scheme is very comprehensive and has great potential, it has to be administered properly all over the country, she said.
According to the 2007 report filed by the Working Group on Children under Six, only about one per cent of the Union budget is spent on children under six years of age - that is, those who genuinely need help from anganwadis don't get it. "Most children don't visit us at the AWC. Sometimes we also fail in our duty to reach out to them. This is especially true of the last few years because we feel highly demotivated and pressurised to fill registers despite knowing that the data being entered is not accurate," rued Parvati.
"In terms of physical infrastructure, about 17 lakh AWCs are needed to cover our entire population - 11 lakh more than what we currently have," said Dipa Sinha from the team of Commissioners to the Supreme Court (CWP 196/2001), recently appointed to ensure that apex court's order regarding universalisation of AWCs and right to food for all gets properly implemented.
"Further, the government should first get all the current vacancies in the existing AWCs filled by conducting exams and selecting capable candidates on a priority basis," said Hemlata. Data shows that there are 2,551 CDPO seats, 16,245 supervisor seats, 69,924 AWW seats and 1,21,896 anganwadi helper seats lying vacant at the end of 2009. "The government has to get proactive, advertise about vacancies and get them filled, besides setting up new AWCs," she added.
The Focus on Children under Six Report of 2006 (abridged) also highlights the fact that not only is there a need to make more AWCs available with adequate facilities like nutritious food, pre-school education material, drinking water, toilets, seating arrangement for children etc, but there is also a need to achieve universalisation of AWCs across the length and breadth of this country, but with quality services that are distributed with equity.
"The overworked AWW can be given some relief by appointing a second AWW, besides better remuneration. Coordination between the health workers and AWWs has to be improved, with full attention given to ensuring health rights of children, mothers and adolescents through the anganwadi," Sinha told Hardnews
"The AWW's salary should be increased to match the rising prices. One also has to reorient all the administrators, right from the top. All village-level workers, including AWWs and helpers, should be motivated again about the purpose of running an AWC. Consistent dialogue and communication at all levels are needed to understand the importance of caring about the health of women and children in the community," said Prof Ritupriya Mehrotra, Centre of Social Medicine and Community Health, Jawaharlal Nehru University.
"Just because the government didn't start such community processes earlier, it doesn't mean they cannot be put in place now. After all, ICDS is a very large, comprehensive public programme with huge potential and outreach, if administered conscientiously," she added.
G Dilip Diwakar, who is researching ICDS in Kancheepuram district of Tamil Nadu, said, "The state government has to be given credit for increasing the salary of AWWs and helpers, providing pension to workers who have completed 30 years of service, and giving AWCs all the required materials to run them effectively. Children and mothers are fed well with a rich diet of sathumavu (nutritious powder made of cereals and sugar), eggs and vegetables in different combinations on different days and in sufficient quantity. Tamil Nadu is a privileged state in this context."
This positive experience can be repeated in many other states if the government and the administrators show will-power and sensitivity towards women and children. There is a certain correlation between good nutrition, reduced morbidity and mortality rates that must not be forgotten.
From the print issue of Hardnews : OCTOBER 2010