The perceptions of Anganwadi workers and mothers of the importance of nutritional care of children during the first 3 years of life : a study of Jharkhand, India
India has the highest prevalence of child malnutrition in the world and is ranked among the worst performing Commonwealth countries in terms of child undernutrition. This poor performance is despite the implementation of the Integrated Child Development Scheme (ICDS) since 1975, which seeks to combat malnutrition through community-based Anganwadi workers. Anganwadi workers play a pivotal role in the implementation of the ICDS Programme and thus their understanding of the key concepts relating to the services provided at the centres is crucial. This study is carried out in the Indian state of Jharkhand, where almost half of the population is undernourished. The study seeks to gain insights on the understanding and perceptions of Anganwadi workers and the mothers with whom they interact, regarding the long term impact of being malnourished in the first 3 years of life. The study used a qualitative approach, with data collection methods including focus group discussions as well as individual in-depth interviews. The study findings suggest that the majority of Anganwadi workers know about the services provided. However, they were unable to state the reasons underlying why these services are important. Mothers on the other hand could only mention three out of six services and many mentioned that the services were scheduled on certain days. In addition, mothers were concerned about the services provided and mentioned that there was poor information sharing even though at times they expressed an interest in the programme. The knowledge of Anganwadi workers about the importance of nutrition in the first three years of life was limited. The same was observed among the mothers in this study. Anganwadi workers identified deficiencies in their training as a reason for their limited understanding about issues pertaining to nutrition within the programme. In conclusion, this study suggests a general lack of knowledge about programme components amongst the Anganwadi workers and mothers. The ICDS programme has failed to develop an understanding about the service components, its importance and consequences for malnutrition. Furthermore, there are limited services offered at the centre, presenting missed opportunities. This has resulted in mothers being deprived of important information which may be crucial in improving child survival and cognitive development. There is thus an urgent need to evaluate ICDS training provided to Anganwadi workers as well as constant retraining to reinforce critical messages. This will ensure that there is congruence between training and practice in the largest nutrition programme in the world.