Gopalakrishnan Lakshmi, Patil Sumeet, Fernald Lia, Walker Dilys, Diamond-Smith Nadia
University of California, San Francisco, California, United States of America.
NEERMAN, Unit 3, Mahendra Industrial Estate, Mumbai, Maharashtra, India.
PLoS One. 2025 Jul 18;20(7):e0326971. doi: 10.1371/journal.pone.0326971. eCollection 2025.
India's 1.4 million Anganwadi Workers (AWW), a type of community health worker (CHW), serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) program. They play a crucial role in facilitating the delivery of nutrition services at the village level in India. Despite this, quantitative evidence regarding the factors that influence the service delivery of AWW in India is limited.
We used data from 6653 mothers of children below 12 months, 2398 pregnant women, and 1344 AWW from 841 villages in Bihar and Madhya Pradesh collected in 2018-19. AWW performance was operationalized as product-oriented services, such as growth monitoring and supplementary food, and information-oriented services, such as the number of home visits and counseling on infant and young child feeding practices (IYCF). We fitted multivariate logistic regression models for each outcome using a set of AWW variables, applying the Means, Motives, and Opportunity (MMO) framework: means (AWW capabilities, including education and experience), motives (AWW willingness to perform, including motivation and supervision), and opportunities (AWW chance to perform, including training, AWW caste, and workload).
Regarding product-oriented services, approximately 48% of beneficiaries received growth monitoring services, 52% of women received take-home rations, and 20% received hot-cooked meals. Regarding information-oriented service delivery, more than a third (37%) received home visits, and 45% of women got counseling on IYCF. Opportunity-related factors such as AWW caste, training, and availability of facilities and resources were significantly associated with the receipt of product-oriented services. For information-oriented services, motives and opportunity-related factors were significantly associated, including motivation, timely salary receipt, AWW caste, supervision, and training.
Harnessing CHWs' skills and performance could address healthcare system challenges, extend program reach, and accelerate progress toward Universal Health Coverage. Our research underscored the importance of factors such as training, access to resources, and service delivery of AWW.
印度140万名安格班瓦迪工作人员（AWW）是一类社区卫生工作者（CHW），在综合儿童发展服务（ICDS）项目下为1.58亿受益人提供服务。他们在促进印度村级营养服务的提供方面发挥着关键作用。尽管如此，关于影响印度AWW服务提供的因素的定量证据有限。
我们使用了2018 - 19年从比哈尔邦和中央邦841个村庄收集的6653名12个月以下儿童的母亲、2398名孕妇和1344名AWW的数据。AWW的绩效通过以产品为导向的服务（如生长监测和补充食品）以及以信息为导向的服务（如家访次数和婴幼儿喂养实践咨询）来衡量。我们使用一套AWW变量，应用手段、动机和机会（MMO）框架，为每个结果拟合多元逻辑回归模型：手段（AWW能力，包括教育程度和经验）、动机（AWW执行意愿，包括积极性和监督）以及机会（AWW执行机会，包括培训、AWW种姓和工作量）。
关于以产品为导向的服务，约48%的受益人接受了生长监测服务，52%的妇女领取了家庭配给口粮，20%的人获得了热餐。关于以信息为导向的服务提供，超过三分之一（37%）的人接受了家访，45%的妇女获得了婴幼儿喂养实践咨询。与机会相关的因素，如AWW种姓、培训以及设施和资源的可用性，与接受以产品为导向的服务显著相关。对于以信息为导向的服务，动机和与机会相关的因素显著相关，包括积极性、及时领取工资、AWW种姓、监督和培训。
利用社区卫生工作者的技能和绩效可以应对医疗系统挑战、扩大项目覆盖范围并加速实现全民健康覆盖的进程。我们的研究强调了培训、资源获取和AWW服务提供等因素的重要性。
