Anganwadi worker time use in Madhya Pradesh, India: a cross-sectional study
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RESEARCH ARTICLE
Open Access
Anganwadi worker time use in Madhya Pradesh, India: a cross-sectional study Anoop Jain1* , Dilys M. Walker2, Rasmi Avula3, Nadia Diamond-Smith2, Lakshmi Gopalakrishnan4, Purnima Menon3, Sneha Nimmagadda5, Sumeet R. Patil5 and Lia C. H. Fernald4
Abstract Background: Anganwadi Workers (AWWs) are a group of 1.4 million community health workers that operate throughout rural India as a part of the Integrated Child Development Services program. AWWs are responsible for disseminating key health information regarding nutrition, family planning, and immunizations to the women and children in their catchment area, while maintaining detailed registers that track key beneficiary data, updates on health status, and supply inventory beneficiaries. There is a need to understand how AWWs spend their time on all of these activities given all of their responsibilities, and the factors that are associated with their time use. Methods: This cross-sectional study conducted in Madhya Pradesh, collected time use data from AWWs using a standard approach in which we asked participants how much time they spent on various activities. Additionally, we estimated a logistic regression model to elucidate what AWW characteristics are associated with time use. Results: We found that AWWs spend substantial amounts of time on administrative tasks, such as filling out their paper registers. Additionally, we explored the associations between various AWW characteristics and their likelihood of spending the expected amount of time on preschool work, filling out their registers, feeding children, and conducting home visits. We found a positive significant association between AWW education and their likelihood of filling out their registers. Conclusions: AWWs spend substantial amounts of time on administrative tasks, which could take away from their ability to spend time on providing direct care. Additionally, future research should explore why AWW characteristics matter and how such factors can be addressed to improve AWWs’ performance and should explore the associations between Anganwadi Center characteristics and AWW time use. Keywords: Time use, Anganwadi workers, Maternal & Child Health, India, Madhya Pradesh
Introduction Background
The role of community health workers (CHWs) has expanded considerably over the past 50 years, especially in low-and-middle-income countries (LMICs) [1]. A World Health Organization (WHO) report from 2016 highlights the chronic shortage of experienced health care workers in LMICs [2]. Many of these countries, for * Correspondence: [email protected] 1 Harvard University, Boston, USA Full list of author information is available at the end of the article
example, are simply unable to train and sustain an educated health workforce needed to ensure well-being and good health [2]. Thus, the burden of reducing morbidity and mortality, particularly in poor countries, often falls on the shoulders of a limited number of trained health care workers [2]. Task-shifting, a strategy proposed in
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