Anganwadi Centres (AWC) serve as the first outpost for health, nutrition and early learning services at the village level. Anganwadi worker (AWW) and an Anganwadi Helper (AWH) are the crucial components of the scheme. Along with Accredited Social Health Activist (ASHA) workers and Auxiliary Nurse Midwives (ANMs), they form the last mile soldiers in our fight against malnutrition. The POSHAN Abhiyaan, launched on March 8, 2018 by Prime Minister Modi in Jhunjhunu, aims to reduce stunting, wasting and anaemia. It will not be wrong to say that the front-line workers of the Integrated Child Development Scheme (ICDS) and health department are the primary human resources on the ground whose motivation and involvement with communities will be the key in deciding the success of the mission.
Women health workers are the pivot of the healthcare system for implementing national health programmes in rural India. However, proper training is required to accomplish the goal of introducing change in the health-related behaviour of people. The front-line workers are supposed to visit households in their respective villages regularly to popularise nutrition interventions with pregnant and lactating women, and their families. They also promote the utilisation of healthcare services. This requires strong communication skills along with proper subject knowledge.
As we know, the first 1000 days of life (from conception to a child’s second birthday) are critical for ensuring good nutrition. Failing to do so has long-lasting, irreversible consequences into adulthood, including stunted growth and brain development, resulting in a stunted nation with poor education and productivity indices, and poor health conditions of the work force. Evidence shows that consistent and systematic interpersonal communication (IPC) is critical for changing maternal infant and young child feeding (MIYCF) related behaviours and practices (UNICEF 2013). While the front-line workers of ICDS and health programmes are best suited to support behavioural change, currently neither they nor their supervisors are focused on it.
Though most of the interventions are known to the front-line workers, they lack the specific details of interventions and do not communicate the details required. Based on the results of various nutrition related projects, it has been observed that the overall knowledge and perceptions for promoting community-based practices is average amongst the ICDS AWWs. The AWWs are aware of key IYCF practices, however their perceptions and knowledge about the rationale applicable to recommended nutrition practices is rather poor. This is a critical gap and needs to be addressed by equipping the ICDS front-line workers to effectively promote successful adoption of good nutrition practices by the community.
The actions expected from the AWWs are apparently simple, but numerous and wide ranging, demanding different skills in pre-school education, health and nutrition, accounting and coordination. The range of beneficiaries is wide, from adolescents to mothers, young infants and pre-school children. Each group requires a different set of engagement skills and approaches. Among the numerous tasks expected of the AWWs, there are a few key tasks that are critical that require soft interventions in the area of behaviour change. Ensuring the development of such practical job skills and pragmatic grasp of priorities is not merely a function of ‘training’, but one of effective, day-to-day ‘programme management’.
Acknowledging the huge gap, the Ministry of Women and Child, under the POSHAN Abhiyaan, has focussed its attention on capacity building of ICDS functionaries using an Incremental Learning Approach (ILA). This approach focusses on imparting small amounts of learning incrementally, until all skills, understanding and actions have been put into regular practice, and internalised by the functionaries. The final step is the establishment of a supportive supervisory mechanism.
Successful implementation of ILA at all levels will be critical in energising the large work force under ICDS. It is important that along with the provision of specific and detailed information to the front-line workers about each critical intervention, their supervisors and block and district level managers shift their focus to the behavioural change activities in their reviews and field interactions. The Jan Andolan for behavioural change, by synergising all the front-line workers, will only be successful if we energise them with adequate counselling skills, knowledge and right motivation.