Evaluation of the Performance of Anganwadi Workers in Delivering Integrated Child Development Services in the Rural Field Practice Area of a Tertiary Medical College in South India.

Background and objective To meet the overall developmental needs of children below six years, adolescent girls, and expectant and nursing mothers, the Integrated Child Development Services (ICDS) was launched on 2nd October 1975 via the network of Anganwadis. It included a range of services like supplementary nutrition, preschool education, immunization, health check-up, referral services, and nutrition and health education. The majority of Karnataka's population resides in rural areas (61.3%) and among them, children (aged zero to six years) constitute around 12.05%. The incidence of mortality and morbidity among vulnerable groups is quite high. A total of 204 ICDS project areas have been sanctioned in Karnataka till 2012, out of which 63,377 Anganwadi centers (AWCs) from 185 projects have been functional. Findings show an alarming gap of 12 million beneficiaries for the required services.Mere 44% of children between 12 and 23 months have received complete immunization. The scheme has reached a stage where enriching its contents is more crucial than concentrating on universalization. Our study has tried to recognize the hindrances in the delivery of ICDS services by evaluating the performance of Anganwadi workers (AWWs), which in turn will optimize the benefit for the beneficiaries. Materials and methods This was a community-based, cross-sectional, descriptive study conducted over a period of six months. The tertiary medical college covers a population of 16,231 in its rural catchment area, whose health needs are served by 21 AWCs. All 21 centers were included in the study through the universal sampling method. Data collection commenced after obtaining clearance from the Institutional Ethics Committee and permission from the Program Officer and Child Development Project Officer (CDPO) of the concerned ICDS block. Informed consent was taken from all the AWWs. Data to evaluate the performance of AWWs were collected using a pre-validated and pre-structured questionnaire. Performance was evaluated by allotting scores to each question. Results Among the 21 AWWs interviewed, 38.1% belonged to the age group of 41-50 years. Of them, 76.2% achieved the correct number of target home visits per day. Growth charts were plotted correctly by the workers in only 60% of centers. Only 57.1% of centers stored raw food materials safely, away from infestation. In 71.4% of centers, the health staff had immunized the children appropriately. Only 38.1% of AWWs had the knowledge of giving paracetamol tablets to the mothers in case of fever and were also giving vitamin syrup to the children. Only 19% of AWWs responded correctly regarding the importance of Village Health and Nutrition Days (VHND). In our study, 11 (52.4%) workers had "good" knowledge about delivering different services under the ICDS scheme, eight (38.1%) had "poor" knowledge while two (9.5%) workers had "satisfactory" knowledge. Conclusion The present study gives some insight into the existing situation in rural AWCs. Although the majority of AWWs had good knowledge about delivering different services under the ICDS scheme, further improvement is needed for optimizing the outcome.