(The Gist of Kurukshetra) ROLE OF
ANGANWADI WORKERS AND ASHAS IN CURBING
MALNUTRITION [JANUARY-2020]
ROLE OF ANGANWADI WORKERS AND ASHAS IN
CURBING MALNUTRITION
Introduction:
India persistently faces high levels of maternal and child under-nutrition as
well as anaemia, characterized by an inter-generational cycle that is compounded
by multiple deprivations caused by poverty, social exclusion and deeply
entrenched gender discrimination. Decreasing child mortality and improving
maternal health depend on reducing malnutrition which is directly or indirectly
responsible for 35 percent of deaths among children under five.
Under-nutrition in infants and children is further categorized as Severe
Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM).
- Severe Acute Malnutrition (SAM) refers to very low weight for height (<
3z scores of the median), visible severe wasting, or the presence of
nutritional oedema.
- Moderate Acute Malnutrition (MAM) is defined as a weight-for-age between
-3 and -2 z-scores below the median. It can be due to a low weight for
height (wasting) or a low height-for-age (stunting) or to a combination of
both. Similarly, moderate wasting refers to weight-for-height between -3 and
-2 z-scores while moderate stunting refers to height-for age between -3 and
-2 z-scores.
Causes of Malnutrition:
- Malnutrition is a complex multidimensional issue. It is caused due to a
number of generic factors such as poverty, inadequate food consumption (due
to poor availability/access), inequitable food distribution, poor maternal
nutrition, sub-optimal infant feeding and child care practices,
inequity/gender imbalances, poor sanitary and environmental conditions, and
restricted access to quality health care, education and social safety-net
services/facilities.
- Further, various economic, environmental, geographical, agricultural,
cultural, health and governance issues complement the general factors in
causing under-nutrition in children.
Nutrition/Health Interventions:
- For eradicating malnutrition in the country, the direct targeted
interventions include schemes/programmes like Integrated Child Development
Services (ICDS), POSHAN Abhiyaan, National Health Mission (NHM), Mid-Day
Meal Scheme and Scheme for Adolescent Girls, Pradhan Mantri Matru Vandana
Yojana.
- In addition, various indirect multi-sectoral interventions/schemes
having potential to address one or the other aspect related to nutrition
include Swachh Bharat Mission (Ministry of Drinking Water & Sanitation/DW&S),
Public Distribution System/PDS (Ministry of Consumer Affairs, Food & Public
Distribution/CAF&PD), Mahatma Gandhi National Rural Employment Guarantee
Scheme/MGNREGS (Ministry of Rural Development/MoRD), Drinking Water &
Toilets (Ministry of Panchayati Raj and Ministry of Urban Development via
the Urban Local Bodies).
Role of Anganwadi Workers and ASHAs:
- Anganwadi Workers and the ASHA workers are the grassroots level
functionaries under the umbrella ICDS Scheme and the National Health Mission
respectively.
- Both these functionaries being closely connected with the rural and
urban poor families, play a pivotal role in addressing their nutrition and
health related problems/issues.
Roles and Responsibilities of Anganwadi Workers:
Under the ICDS Scheme, Anganwadi Services were launched in 1975 as a pilot
project covering 33 blocks in the country; its objectives are:
- To improve nutritional and health status of children in the age-group
0-6 years;
- To lay the foundation for proper psychological, physical and social
development of the child;
- To reduce the incidence of mortality, morbidity, malnutrition and school
dropouts;
- To achieve effective coordination of policies and implementation
strategies among the various departments for promoting child development;
and
- To enhance the capability of the mothers to look after the normal health
and nutritional needs of their children through proper nutrition and health
education.
Package of services under the ICDS scheme:
- Supplementary nutrition
- Pre-school non-formal education
- Nutrition & health education
- Immunization
- Health check-up
- Referral services
Out of the six, three health related services viz., immunization, health
check-up and referral services are provided by NRHM & Public Health
Infrastructure. This convergence is facilitated by the grassroot level
functionaries i.e. AWWs (Anganwadi Services Scheme) and the ANMs/ASHA Workers
(Ministry of Health & Family Welfare) through:
- Observance of monthly Village Health and Nutrition Days (VHND) at AWCs-
immunization, ANC/PNC etc.;
- Referral of sick/malnourished children by AWWs to health facilities and
the ANMs;
- Biannual rounds of Vitamin A supplementation (in several States);
- Use of joint Mother Child Protection (MCP) cards by ANM and AWWs;
- Participation at the Village Health Sanitation and Nutrition Committee (VHSNC)
meetings;
- Monthly meetings by ANM and AWW at the sub-centre level; and joint
training conducted by NRHM.
Roles and Responsibilities of Anganwadi Workers:
- To elicit community support and participation in running the programme.
- To weigh each child every month and plotting it on the growth card;
maintain the child cards (for children below 6 years) to be examined by the
visiting medical/para-medical personnel; and using the referral cards for
referring mothers/children to the sub-centre/PHC etc.
- To carry out, annually, a quick survey of all the families in their
respective area of work with particular attention to the mothers and
children.
- To organise non-formal pre-school activities for children aged 3-6 years
and to help in designing/making toys out of indigenous resources.
- To organise supplementary nutrition feeding for infants/children (below
6 years) as well as pregnant women and nursing mothers via planning of menu
based on locally available food/local recipes.
- To provide health/nutrition education along with counselling on
breastfeeding as well as infant/young child feeding practices to the
mothers. Further, anganwadi workers being rather close to the local
community can motivate the married women for adopting family planning
practices/birth control measures.
- To help and coordinate the health centre visits of pregnant
women/nursing mothers for registering their child's birth and reporting the
same to the village level functionary notified as Registrar of Births.
- To conduct home visits for educating the parents, especially the
mothers, for enabling them to play an effective role in their child's growth
and development with particular emphasis on that of the newborn child.
- To assist the PHC staff in effective implementation of the programme's
health component viz. immunization, health checkups and ante-natal/postnatal
check-ups etc.
- To assist the ANMs in the administration of IFA tablets (for anaemia
control) and vitamin A doses (for preventing VAD) to the beneficiaries.
- To share the health-related information with the ANM.
- To support in organizing Pulse Polio Immunization (PPI) drives.
- To inform the ANM regarding any emergency cases like diarrhoea, cholera
etc.
- To guide ASHAs (Accredited Social Health Activists under NRHM) in the
delivery of healthcare services and maintaining the records.
- Anganwadi Workers can act as depot holders for RCH Kit/contraceptives
and disposable delivery kits, though the actual responsibility lies with the
ANMs or ASHAs except that for over-the counter drugs.
- To assist in implementing Scheme for Adolescent Girls (SAG) and
motivate/educate the adolescent girls, their parents and community as a
whole by organizing social awareness programmes/campaigns etc. Also, to
assist in implementing the Nutrition Programme for Adolescent Girls (NPAG)
and maintaining the records.
- During home visits, to identify disability among children and referring
them immediately to the nearest PHC or District Disability Rehabilitation
Centre.
- To inform the Supervisors/CDPO regarding any village level developments
requiring their attention and intervention, particularly for the
coordinating arrangements with different departments.
- To maintain liaison with other institutions (eg. Mahila Mandals) and to
involve school teachers (women only) and primary/middle school girl students
of the village, where necessary.
Roles and Responsibilities of ASHA Workers:
- ASHA workers are expected to elicit community participation in public
health programmes in the village. She is the first person to be called for
any health-related needs of the deprived sections of the population,
especially women and children, who find it difficult to access healthcare
services. ASHAs are the community-level health activist for creating
awareness on health and its social determinants as well as for mobilizing
the community towards local health planning and increased
utilization/accountability of the existing health services.
- They are promoters of good health practices. In addition, they provide a
minimum package of appropriate and feasible curative care or arrange for
timely referrals.
- They generate community awareness concerning the various determinants of
health such as nutrition, basic sanitation & hygienic practices and healthy
living/working conditions, as well as regarding the existing healthcare
services and the importance of timely utilisation of health & family welfare
services.
- They counsel women on birth preparedness, importance of safe delivery,
breastfeeding & complementary feeding, appropriate care of the young child,
immunization, contraception and prevention of common infections including
reproductive tract infections/sexually transmitted infections (RTIs/STIs).
- They mobilise the community and facilitate their accessing health/health
related services such as immunisation, antenatal/postnatal check-ups(ANC/PNC),
supplementary nutrition, sanitation and other governmental services
available at the anganwadi/sub-centre/primary health centres.
- They act as depot holders for essential provisions like Oral Rehydration
Solution (ORS), Iron Folic Acid tablets (IFA), chloroquine, Disposable
Delivery Kits (DDK), oral contraceptive pills & condoms, etc.
- Since ASHAs cannot function without adequate institutional support at
the village level, women's committees (self-help groups/women's health
committees), village health & sanitation committee (Gram Panchayat),
peripheral health workers especially ANMs and Anganwadi workers, and the
ASHA trainers (for periodic in-service training) provide them the needed
support.
- Recently, Home-Based-Care for Young Children (HBYC) has been initiated
to extend the community-based-care by ASHA workers with particular focus on
nutrition counselling, improved child rearing practices and breastfeeding
promotion etc.