Envisioning a healthy future for children: Role of integrated child development services and anganwadi workers in health education and malnutrition in Mumbai, India

Objectives: The Integrated Child Development Services (ICDS) is a nationwide welfare program in India to promote and address malnutrition and health problems in underserved children (0-6 years) and pregnant mothers. A primary component of this service is the Anganwadi center (AC) and its Anganwadi workers (AWW) whose duties include supplementary nutrition, preschool education, preventive health and immunization related education. This study aims at examining the role of AWWs in nutrition and health status and dissemination of health related information in the slums of Mumbai, India. Methods: Key informant interviews with the ICDS government officials, AWWs, non-governmental organizations (NGO's), private and governmental clinicians were conducted. Families of 72 children who attended the AC were surveyed. Results: About a quarter of the children in these centers indicated that they were underweight once in their lifetime. With this service, 93% of children in AC reported that they ate at least one meal apart from their home. About 83% families had received preventive health education for hygiene, sanitation and immunization from one or multiple sources, and AWW accounted for the highest impact (69%). Further, families preferred subsidized governmental immunization services (83%) over private clinics (11%). Conclusion: The present study shows the reach of AWWs at grassroots level on nutrition, preventive health and education among underprivileged children. Such initiatives are indispensable for provision of preventive healthcare services despite limited resources, low income and inadequate training of AWWs. Government initiatives like ICDS are steps in right direction and can serve as a directive in other communities