CERTIFICATE

Certified that the following 7th Semester students have submitted their project entitled ‘A
study on client satisfaction about different services under ICDS scheme in AWCs of
Guwahati City’ under the guidance of Dr. Jutika Ojah, Professor, Department of Community
Medicine, Gauhati Medical College.
PROJECT MEMBERS:
SL.NO. NAME ROLL NUMBER
1. TAPAN JYOTI SAIKIA 2

2. NAMRATA NATH 15

3. ANUPAM TAMULI 28

4. ASHRAFUL ALOM 41

5. PRABHAT KUMAR KAIRI 54

6. RIZWAN AHMED TAPADAR 67

7. PIYUSH SINGH 80

8. JYOTI REKHA RABHA 93

9. MONDEEP SRIKANT 119

10 ITHIANGHUN SANA 106

. 11. JUNAID AKHTAR 132

12. RAHIL ALAM 145

13. RISHAV RAJGURU 158

Signature of Head of the Department Signature of Group Teacher

Dr. Anku Moni Saikia Dr. Jutika Ojah
Professor and HOD Professor
Dept. of Community Medicine, Dept. of Community Medicine,
GMCH GMCH
 ACKNOWLEDGEMENT

It gives us immense pleasure in bringing out the project entitled:

‘’A Cross Sectional study on client satisfaction about different services under ICDS scheme in
AWCs of Guwahati City.’’

First, we would like to offer our utmost gratitude to the department of community
medicine GMCH for granting our group this golden opportunity of making a variable project and
helping us explore more in the subject of community medicine. Especially to get an insight of the
basics of how data collection and analysis are done along with the importance of knowledge on
the knowhow and skills that are called for towards making a project and for helping us work on a
topic so relevant of important.

We would like to thank our guide, Professor Dr. Jutika Ojah, who helped us with her
valuable suggestions and ideas when we were in need. Her constant support and adept advice
have helped to make this project successful.

We also profoundly thank Dr. Ankumoni Saikia, professor and Head of the Department
of community medicine, GMCH for her guidance and support throughout the work.

Our group would be blessed if the data and information in this project help in improving
the functioning of AWCs in the state as well as in the country.

Gauhati Medical College & Hospital Sincerely,

Bhangagarh, The project Team

Guwahati-32 Roll-Nos.:

2,15,28,41,54,67,80,93,

106,119,132,145,158
 CONTENTS

CHAPTERS PAGE NO:

1. INTRODUCTION 1-2
2. OBJECTIVES 3
3. REVIEW OF LITERATURE 4-6
4. MATERIALS AND METHODS 7-8
5. RESULTS AND OBSERVATIONS 9- 33
6. DISCUSSION 34-35
7. SUMMARY 36-38
8. CONCLUSION 39
9. RECOMMENDATIONS 40

LIST OF ANNEXURES
ANNEXURE- I - BIBLIOGRAPHY [1]-[3]
ANNEXURE-II - PROFORMA [4]-[9]
ANNEXURE-III – ABBREVIATIONS [10]
ANNEXURE-IV – GANTT CHART [11]
ANNEXURE-V - IMAGE GALLERY [12]
 INTRODUCTION

Integrated Child Development Scheme (ICDS) was launched on 2 October, 1975; the
106 birth anniversary of Mahatma Gandhi- the father of the nation. ICDS is the most unique
th

programme for early childhood care and development encompassing integrated services for
development of children below 6 years, expectant and nursing mothers in the most backward
rural, urban and tribal areas[1] .The focal point for the delivery of ICDS services for mothers and
children is an Angan (literally meaning “the courtyard shelter”) which is run by an Anganwadi
worker (AWW) and a helper. As of June 2019, Assam has a total of 62153 functional
Anganwadi Centers (AWCs)[2] . Currently the most important scheme in the field of child
welfare is the ICDS scheme. The blueprint for the scheme was prepared by the Department of
Social welfare. The ICDS seeks to lay a solid foundation for the development of the nation’s
human resource by providing an integrated package of early childhood services which include-

1] Supplementary nutrition

2] Immunization

3] Health check up

4] Medical referral services

5] Nutrition and health education for women

6] Non formal education for children up to 6 years

Considering the magnitude of the task, it was decided to take up on an experimental basis
33 projects in the year 1975-76 in 4 urban, 19 rural and 10 tribal areas spread over 22 states and
the Union Territory of Delhi. The projects were sanctioned in October 1975. The Government of
India decided to expand the project to cover 100 areas by 1978-79. Two major evaluations were
conducted in 1978 and 1982. The positive results of these evaluations formed the basis for the
government’s decision to accelerate the expansion of ICDS in 1982.

Prior to 2005-06, providing supplementary nutrition was the responsibility of the states
and administrative cost was provided by the central government. Government of India has
modified the cost sharing pattern under ICDS by giving aid of 50 per cent of the financial
expenditure to the states/UTs.[3]

Beneficiary Services

1
Pregnant women Health checkup

Immunization against tetanus

Supplementary nutrition

Nutrition and health education

Nursing mothers Health check up

Supplementary nutrition

Nutrition and health education

Other women 15-45 years Nutrition and health education

Children less than 3 years Supplementary nutrition

Immunization

Health check up

Referral services

Children in age group 3-6 years Supplementary nutrition

Immunization

Health check up

Referral services

Non formal education

Adolescent girls 11-18 years Supplementary nutrition

Nutrition and health education

Though ICDS is the world’s largest community based child nutrition and development
programme, even after more than 35 years of its implementation, the dilemma still exists
regarding the extent of utilization and quality of services provided through Anganwadis [4].
Therefore, the present study tries to highlight regarding the awareness, utilization and client
satisfaction about different services under ICDS scheme in AWCs of Guwahati city, which is a
cross sectional study on the population of Guwahati City.

2
 OBJECTIVES OF THE STUDY

General Objective:-

To study the client satisfaction about different services under ICDS scheme in AWCs of
Guwahati City.

Specific Objectives:-

1. To assess the awareness of beneficiaries regarding the services provided under ICDS scheme
in Guwahati City.

2. To study utilization of services by the beneficiaries under ICDS in Guwahati city.

3. To assess the level of satisfaction among the beneficiaries with regards to the Anganwadi
Centers and Anganwadi Workers in Guwahati city.

3
 REVIEW OF LITERATURE

• In a study titled "Utilization of ICDS Scheme in Urban and Rural Areas of Latur District
with Special Reference to Paediatric Beneficiaries" [6] conducted by the Department of
Community Medicine, MIMSR Medical College, to study and compare utilization of services
provided under ICDS to children attending Anganwadi Center in urban and rural area of Latur
district, it was found that of all the services provided by the AWCs, the difference between
urban and rural areas was statistically significant in only two areas which are supplementary
nutrition and IFA prophylaxis with the number of beneficiaries being higher in Urban area for
the former and Rural area for the latter

• In a study titled "An assessment of facilities and activities under integrated child
development services in a city of Darjeeling district, West Bengal, India" [7]conducted by
Department of Community Medicine, North Bengal Medical College and Hospital to assess
the facilities and activities of ICDS centers in Siliguri city of Darjeeling district and utilization
of ICDS services among children 6 months to 6 years of age, it was found that there was a gap
in infrastructure facilities of Anganwadi centers particularly toilet facilities, indoor floor
space, separate kitchen and electricity. There was gap in certain activities like regular health
checkups, referral services and regularity of supplementary food, AWWs were well trained
and all other facilities were provided according to programme guidelines

• In a cross sectional, descriptive study titled "Awareness and Perception of Mothers about
Functioning and Different Services of ICDS in Two Districts of West Bengal" [8]conducted
by the department of Community Medicine, Burdwan Medical College, West Bengal, it was
found that a total of 1235 mothers were included as study subjects. As per opinion of the
mothers 73% AWCs opened regularly, behaviour of the AWWs was friendly (71.6%) and
63% mothers opined that ICDS is beneficial to their children. About 84.2% mothers were
aware of any ICDS services. Quantity and quality of supplementary food was acceptable to
88% and 72.7% mothers respectively while 79.2% and 87.5% mothers did not receive any
advice on child feeding and growth chart.

• In a cross-sectional study titled "A Study on Utilization and Satisfaction of ICDS Services
in Anganwadis of Urban Bhopal"[10]conducted by Department of Community Medicine,
Bhopal, Madhya Pradesh, India it was found that overall satisfaction and utilization of ICDS
services were high in urban Anganwadi centers of Bhopal

• In a study titled "Utilization of Integrated Child Development Services (ICDS) Scheme by

child beneficiaries in Coastal Karnataka, India" [11]conducted by Department of
Community Medicine, Kasturba Medical College to assess the utilization of ICDS services
from the child beneficiaries in the age group three to six years, it was found that the children
in the age group three to six years were attending Anganwadi centers for a median duration of

4
 only 12 months out of expected 36 months as children in the higher age groups were attending
private nursery schools. Amongst the children whose weight was recorded and plotted
accurately about three fourths children’s weight remained well within normal range. About
two thirds of the mothers of children were not happy with the quality of food offered to their
children and only about half of the mothers of children attended the nutrition and health
education sessions.

• In a study titled "A cross sectional study on client satisfaction of Anganwadi Centers
under integrated Child Development Services (ICDS) scheme in a slum of
Kolkata"[16]conducted by the Department of Community Medicine, All India Institute of
Hygiene and Personal Health, Kolkata; it was found that majority (63%) had average level of
satisfaction while only 1.4% of mothers were well satisfied and about 35.6% were poorly
satisfied with the services provided by ICDS centers and Anganwadi Workers. The study
concluded that stringent supervision of the ICDS centers must be done to ensure provision of
all services and maintenance of quality of each service. This according to the study would
play a long way in improving maternal and child health.

• G Jostein, Dagrun Kyte, Dititale Utigivelserved, Uio in their study titled “Negotiating
conflicting roles: female community health Workers in rural Rajasthan –a perspective on
Indian Anganwadi Programme",[17] stated the various functions of Anganwadi workers and
the population targeted under ICDS programme however for all this work they are paid very
less salaries, they are no paid –for – performance incentives for them.

• NiyiAwefeso & Anu Ram Mohan from the Discipline of Economics, School of Business,
University of Western Australia, in their study titled “Three decades of Integrated Child
development Service Programme in India; Progress and Problems"; [18] found out that early
childhood development outcomes are important matters of welfare of children. It was also
insisted that the health care 14 workers also known as the Anganwadi workers would be paid
honorarium instead of salaries. three decades of the programme being implemented the
researchers found out that the economic condition of these workers were very low and not
very encouraging for them to work in places far from their homes.

• In the study by Rani P.U titled"ICDS- a study of job performance of supervisors and care
workers",[19]it was found that ICDS is a multi dimensional welfare programme and
achievement of targets depended on job performance of supervisors. The children live under
conditions that give them poor mental and physical development. All this is because the care
workers themselves have poor working and economic conditions.

• In the study by Yadav K., Verma in titled "Perspectives and Policies- a study of care
workers";[20]the authors concluded that part time child workers should be paid not less than
the minimum wages proportionate to their working 18 hours .for this they also suggested
certain measures that can be taken by the government.

5
• In a study by Kapil U.K , Gaur D.R, Sood A.K titled "Nutritional beliefs among Anganwadi
workers";[21] it was found that the Anganwadi workers had abstract knowledge about the
nutritive value of common foods, dietary beliefs during the antenatal and post pregnancy
period and since they are the immediate resource person between the public health services
and the rural population, these Anganwadi workers should be trained at regular intervals so
that their knowledge can be upgraded.

• In a study by Daga R.S, Daga A.S, Dighole R.V, Patil R.P titled "Anganwadi worker’s
participation in rural India"; [22]the author has tried to state that the Anganwadi worker
involved in rural new born care acts as a link between the traditional dais and a health worker.
She ensures that the pre term babies are kept warm at home and very small babies are referred
to hospitals. The training of these workers were conducted during routine monthly basis and
for equipping each was given an amount of mere Rs.110. the author considers this amount to
be very less, not encouraging

• In a study by Udani R.H, Chotani S, Arora S titled "Evaluation of knowledge and efficiency
of Anganwadi workers"[23]; an evaluation of knowledge and competence of Anganwadi
workers employed under ICDS schemes of urban slums of Mumbai (then Bombay) was
carried out an it was found that a significant improvement in the knowledge regarding various
aspects of health and nutrition component occurred after a training programme among the
Anganwadi workers. It was therefore suggested that more frequent and on the job training
should be given to these workers and their performance should also be constantly monitored.

• In a study by Udhani R.H, Patel R.B titled "Impact of knowledge of Anganwadi workers on
Slum community"[24]; poor knowledge in community despite a good performance of the
related Anganwadi workers in examination was revealed. It was therefore suggested by the
authors that an active participation of community in the programme should be encouraged and
the terms should be closer. It was also suggested that there should be frequent supervisions of
these Anganwadi workers

• In a study by Lalitkant, Gupta Amrish Mehta S.P. titled "Profile of Anganwadi Workers and
their knowledge about ICDS"[25]; the authors analyzed the profiles of Anganwadi workers in
Puri, Odisha. In their study, it was found that 83 % of the Anganwadi workers were trained
and 17% of them were not trained. Majority of the workers could not tell even tell the full
form of ICDS scheme. None of them could list out their job responsibilities. It was therefore
recommended by the authors that the existing training of the Anganwadi workers needed to be
evaluated and their socio economic conditions should be strengthened.

6
 MATERIALS AND METHODS

 Study Design:- Cross Sectional Study

 Study Setting:- Anganwadi centers in Guwahati City

 Study Duration:- 8 Months (April, 2019 to November, 2019)

 Study Population:-

Children up to the age of 6 years and their mothers, Adolescent girls up to the age
of 18 years, pregnant women, women 15–45 years of age in Guwahati, currently availing
services provided under ICDS schemes by Anganwadi centers in Guwahati.

 Sample size: 300.

Out of 192 AWCs in Guwahati City,15 AWCs was selected by simple random
sampling. From each center, 7 children aged 3-6 years, 6 pregnant women and 6 Children
aged 0-3 years were taken, thus the total from 15 centers came out to be as 105 children
aged 3-6 years, 90 pregnant women, 90 children aged 0-3 years (90). There is an overall
low attendance of adolescent females in the Anganwadi centers. Hence only 15
adolescent females were found and were included in our study.

 Inclusion criteria:-

Children up to the age of 6 years and their mothers, Adolescent girls up to the age
of 18 years, pregnant women, women 16–44 years of age in Guwahati, who are registered
and are currently availing services provided under ICDS schemes by their local
Anganwadi centers.

 Exclusion criteria:-

1) Refusal to participate

2) Newly inducted beneficiaries (less than one month)

3) Irregular beneficiaries

7
 Data Collection

1) Tools: Predesigned Proforma.

2) Study Variable:

A) Client related variable: Age wise distribution of the population, Age wise
distribution of pregnant female, Gender distribution of Child beneficiaries, Socio-
Economic Status, Educational status of pregnant female, Family type, Religion.

B) Anganwadi Center related variables: Whether AWCS are regularly open, no. of
hours the AWC’s remain open, Cleanliness of AWCs, Infrastructure of AWCS, and
Availability of instruments in AWCs.

C) Anganwadi Worker related variables: Behaviour towards beneficiaries, Regularity

of services, Records maintenance, Advice regarding common disease, Home visits,
Growth monitoring, Non formal education.

D) Nutrition and immunization related variables:- Quality of food, Quantity of food,

Provision of Hot meals, referral for Immunization, Immunization status of beneficiaries,
Vitamin A supplementation

 Study Procedure:-

The selected beneficiaries were carefully briefed regarding the purpose of the
study to get their consent and full co-operation during the study. Each participant was
interviewed in isolation so as to avoid bias in their responses and provide privacy. Data
was collected from selected Anganwadi Centers and mothers of 6 months to 6 years
children were selected for the study. Information on their socio-demographic status and
utilization of ICDS scheme was collected using a structured interview schedule and
observatory checklist. The functioning of AWC and behaviour of Anganwadi Workers
was assessed by interviewing the participants themselves. Infrastructure of AWC,
adequacy and frequency of different services as was assessed by observation.

 Limitations of the Study:-

This study is made by the students with academic purpose. Moreover, because of
the limited opening hours of the Centers and the short duration of the study there have
been time constraints while performing the study.

8
 RESULTS

TABLE 1- Table showing distribution of pregnant women participating in the study

according to age.

Age of the Pregnant Number of participants Percentage

women

<19 13 14.40%

19-29 49 54.40%

29-39 26 28.90%

>39 2 2.30%

TOTAL 90 100%

Comments: Out of 90 beneficiaries who were pregnant women, majority (54.40%) were aged
19-29years, followed by 29-39 years (28.90%) and less than 19 years (14.40%). Only 2.30%
were greater than 39 years of age.

9
FIG.1- Pie Diagram showing the distribution of pregnant women participating in the study
according to their Educational status.

Level of Education amongst the pregnant

women in our study
1%

10% 11%
Illiterate
Below 10th Standard
H.S.L.C Passed
20% H.S Passed
Graduate and above

58%

Comments: Regarding the educational status of the 90 beneficiaries who were pregnant women,
majority (58%) were below 10th standard, followed by H.S.L.C passed (20.00%) and H.S passed
(10%). 11% were illiterate. Only 1% was graduate and above.

10
FIG.2- Pie diagram showing the distribution of beneficiaries according to their type of
family.

Type of Families of the study participants

40.40% Joint Family

Nuclear Family

59.60%

Comments: Out of 300 beneficiaries, majority (59.60%) were from nuclear families. Only
40.40% were from joint families.

11
FIG.3- Pie diagram showing the distribution of children aged 0-6yrs according to their
gender.

Gender distribution of children aged 0-6 years

40.50% Male
Female

59.50%

Comments: Out of all the children aged 3-6 years, majority (59.50%) were male whereas only
40.50% were females.

12
FIG.4- Pie diagram showing the distribution of beneficiaries according to their religion.

Distribution of beneficiaries based on religion

2.00%
8.00%

Hindu
Muslim
Christian
Sikh
35.00% 55.00%

Comments: Out of 300 beneficiaries, majority (55%) were Hindu by religion, followed by
Muslims (35%) and Sikh (8%). Only 2% were Christian.

13
TABLE 2- Table showing distribution of beneficiaries according to their socio-economic
status (According to Modified Kuppuswamy Scale 2019)

Socioeconomic Status Number of participants Percentage

Upper Middle 3 1%

Lower Middle 73 24.33%

Upper Lower 142 47.33%

Lower 82 27.33%

TOTAL 300 100%

Comments: Out of 300 beneficiaries, majority (47.33%) were from upper lower class, followed
by lower class (27.33%) and lower middle class (24.33%). Only 1% was upper middle class. No
respondents belonged to upper class.

14
FIG. 5- Pie diagram showing distribution of respondents based on their opinion on the
opening of their local AWC in that area.

Number of days the AWCs open

15%

Satisfactory : (>200days)
Average: (125-200days)
Poor: (<125days)
50%

35%

Comments: Out of 300 beneficiaries, majority (50%) respondents said their local AWC
remained open for more than 200 days, followed by 125-200 days (35%). Only 15% respondents
said that their local AWCs remained open for less than 125 days.

15
FIG. 6- Pie diagram showing distribution of respondents based on their opinion on the
number of hours for which their local AWCs are open

Number of hours the AWC open

16%

Satisfactory: (>3hrs)
Average: (1.5-3hrs)
Poor: (<1.5hrs)
50%

34%

Comments: Majority of the AWCs (50%) remained open for more than 3 hours per day,
followed by 1.5-3 hours per day (34%). Only 16% were open for less than1.5 hours per day.

16
FIG. 7- Pie diagram showing distribution of respondents based on their opinion on the
cleanliness of their local AWCs.

Cleanliness of the AWC

35% 35%
Adequate: (>7/9 of criteria met)
Average: (5-7/9 of criteria met)
Poor: (<5/9 of criteria met)

30%

Comments: Majority of the AWCs, i.e. 35% were adequately clean (>7/9 criteria) whereas 35 %
were poorly cleaned (< 5/9 criteria). Only 30% were average in cleanliness (5-7/9 criteria)

17
FIG. 8- Pie diagram showing distribution of respondents based on their opinion of the
water availability in their local AWCs.

Water availability in the AWC

35% 34% Satisfactory: Dedicated source

present
Average: Irregular
Poor: More than 20% of days not
available

31%

Comments: Majority of the AWCs, i.e. 35% had water unavailable for more than 20% of days.
The percentage of AWCs having a dedicated source of water present was found to be 34%. Only
31% of AWCs had irregular water supply.

18
FIG. 9- Pie diagram showing distribution of respondents based on the infrastructure and
accessibility in their local AWCs.

Infrastructure and accessibility of AWC

25%
30%

Adequate: (>8/9 of criteria met)

Average: (5-8/9 of criteria met)
Poor: (<5/9 of criteria met)

45%

Comments: Majority of the AWCs (45%) were average (5-8/9 criteria) in terms of infrastructure
and accessibility which was followed by 30% AWCS having poor infrastructure (<5/9 criteria).
Only 25% were adequate (>8/9 criteria).

19
FIG. 10- Pie diagram showing distribution of respondents based on their knowledge on the
availability of instruments in their local AWCs.

Availability of instruments in the AWC

15%

31% Satisfactory: All present and work-

ing
Average: Either some non
functional or only some
present
Poor: Some present of which not
all are functional

54%

Comments: Majority of the AWCs (54%) had either some non functional instruments or only
some instruments were present, followed by 31% AWCs with all instruments present and
working. Only 15% had some instruments present of which not all were functional.

20
FIG. 11- Pie diagram showing the distribution of responses based on the behaviour of the
Anganwadi workers of their local AWC.

Behaviour of the Anganwadi workers

15%

Satisfactory: Kind
Average: Indifferent
Poor: Harsh

25%
60%

Comments: Majority of the respondents found the behaviour of the AWWs as kind (60%),
followed by indifferent (25%). Only 15% found their behaviour harsh.

21
FIG. 12- Pie diagram showing the distribution of responses based on the regular
availability of the facilities in their local AWC.

Regular timing of the facilities

13%
23%

Satisfactory: Regular
Average: Sometimes
Poor: Irregular

64%

Comments: Majority of the respondents reported that their local AWCs (64%) were sometimes
present in their facilities, followed by 23% of the respondents reporting their local AWCs are
regular in their facilities. Only 13% were highly irregular.

22
FIG. 13- Pie diagram showing the distribution of responses based on the regularity of
record maintenance in their local AWC.

Records Maintenance

3%

19%
Satisfactory: Regular
Average: Most of the time
Poor: Irregular

78%

Comments: Majority of the AWCs (78%) were regular in record maintenance, followed by 19%
of the centers maintaining records most of the time. Only 3% were irregular.

23
FIG. 14- Pie diagram showing the distribution of responses based on whether advice
regarding management of common diseases and pregnancy and lactation were given or not.

Advices given by the Anganwadi workers

16%

Given
Not given

84%

Comments: Majority (84%) of the respondents reported that AWWs gave advice regarding
management of common diseases and regarding pregnancy and lactation, whereas 16%
respondents reported that AWWs never gave any advice.

24
FIG. 15- Pie diagram showing the distribution of responses based on the frequency of home
visits done by the Anganwadi workers.

Homevisits

3%

23%
Satisfactory: Monthly
Average: Irregular
Poor: Never

74%

Comments: Majority of the respondents got monthly home visits from the AWWs (74%), 23%
got irregular visits. Only 3% were never visited by AWWs.

25
FIG. 16- Pie diagram showing the distribution of responses based on the growth
monitoring examination done by the Anganwadi workers for children less than 6 yrs of
age.

Growth Monitoring

3%

21%
Satisfactory: Monthly
Average: Irregular
Poor: Never

76%

Comments: Majority of the respondents reported AWWs did monthly growth monitoring (76%),
whereas 21% reported that the AWWs were irregular and 3% reported that AWWs never did
growth monitoring.

26
FIG. 17- Pie diagram showing the distribution of responses based on non formal education
provided by the Anganwadi workers for children 3-6yrs of age.

Non Formal Education

7%

Satisfactory: Given and regular

31% Average: Given and irregular
Poor: Absent

63%

Comments: Out of the all the child beneficiaries of 3-6yrs of age, 63% reported receiving
regular non formal education from AWWs, followed by 30% reported receiving non formal
education irregularly. Only 7% reported receiving no non formal education.

27
FIG. 18- Pie diagram showing the distribution of responses based on the quality of food
provided by their local AWC.

Quality of food

15%
20%

Satisfactory: (>5/7 of criteria met)

Average: (3-5/7 of criteria met)
Poor: (<3/7 of criteria met)

65%

Comments: Majority (65%) of the respondents found the quality of the food average whereas
20% found the food good. Only 15% found it bad.

28
FIG. 19- Pie diagram showing the distribution of responses based on the quantity of food
provided by their local AWC.

Quantity of Food
8%

21%

Satisfactory: Adequate
Average: Irregular
Poor: Inadequate

71%

Comments: Majority (71%) of the respondents found the quantity of the food irregular whereas
21% found the food adequate. Only 8% found it inadequate.

29
FIG. 20- Pie diagram showing the distribution of responses based on the availability of hot
meals for the preschool children in the Anganwadi Centres.

Hot meals for the preschool children

5%

Satisfactory: Regular
40% Average: Most of the time
Poor: Irregular

55%

Comments: Majority of the respondents (55%) said hot meals were provided most of the time
for preschool students whereas 40% said it was regular. Only 5% called it irregular.

30
FIG. 21- Pie diagram showing the distribution of responses based on the presence of
referral services and immunization record maintenance in their local AWC.

Referral services and immunization record

14%
22%

Satisfactory: Frequently
Average: By others and An-
ganwadi workers
Poor: Never by Anganwadi
workers

64%

Comments: Majority (64%) of the respondents said that the referral services and immunization
record was maintained by AWW and others, 22% said it was frequent and 14% said it was never
done by the Anganwadi workers.

31
FIG. 22- Pie diagram showing the distribution of responses based on vitamin A
supplementation and deworming doses provided to below 6yr old children in their local
AWC.

Vitamin A supplementation and de-worming

doses

26% 28%
Satisfactory: According to
program
Average: Sometimes
Poor: Never

47%

Comments: Majority (47%) of the below 6 year olds were given vitamin A supplementation and
deworming doses sometimes whereas 27% got it according to the program. Only 26% never got
it.

32
FIG.23- Pie diagram showing the distribution of responses based on the immunization
status of the child below 2yr old registered in their local AWC.

Immunization status of children below 2yr old

28%

Satisfactory: Completely im-

munized
Average: Incompletely immunized
Poor: Not immunized

72%

Comments: Majority (72%) of the below 2 year olds were completely immunized and 28% had
incomplete immunization status. No respondent reported not receiving any vaccines.

33
 DISCUSSION

Most of the pregnant women interviewed were of the age group 19-29 years (54.40%).
Rest were 29-39 years (28.90%), <19 years (14.40%) and >39 years (2.30%). Of these women,
most (58%) were educated but not above class 10. 20% had matriculated, 10% had finished class
12 and only 1% had attended college. Only 11% women were illiterate. Thus we were dealing
with a mainly young demographic which is similar to the study conducted by Dandotiya et al. [10]
Most of the families interviewed were nuclear in nature (59.60%).

Regarding regularity, most of the AWCs were regularly open as 50% of the AWCs were
open for >200 days per year for >3 hours per day. Rest 35% were open for 125-200 days for 1.5
to 3 hours and 15% were open for <125 days for <1.5 hours.

We found a mixed response regarding cleanliness of the AWCs with 35% of the
respondents finding the AWCs they attended were adequately clean (>7/9 of the criteria were
fulfilled), another 35% (<5/9 criteria fulfilled) finding the cleanliness poor and 30% finding it
average (5-7/9 criteria fulfilled). A similar response was seen regarding water availability as 34%
AWCs had dedicated water source present, 31% had irregular water supply and 35% didn’t have
water supply for more than 20% of the days.

Out of 300, 25% respondents found the AWCs had adequate infrastructure and
accessibility, 45% found it average and 30% found it poor. Instruments were available and
working in only 31% AWCs and 54% either had some non functional or only some instruments
were present. Only 15% had some instruments present of which not all were functional.

Facilities were regularly present in 23% of the AWCs, were present sometimes in 64% of
the AWCs and irregular13% of the AWCs.

Thus we found the AWCs were quite average in their functioning and infrastructure
albeit some irregularity. They were neither outstanding nor disappointing at large.

Since an AWW is at the heart of an AWC, sometimes her behaviour and duties are even
more important than the facilities available at the AWC itself, we decided to enquire about that
too. In our survey, we found that the majority AWWs were largely (60%) kind in their
behaviour, some of them (25%) were indifferent and a minority (15%) were harsh. They were
mostly (78%) regular in record keeping, some (19%) were maintaining the records most of the
time and only 3% were irregular at maintaining records.

34
 Regarding the benefits of the ICDS scheme, we asked the mothers for information about
the child beneficiaries as well. For supplementary nutrition, the quality of the food was good
according to 20% of the mothers, 65% found it average and 15% found it bad. The quantity was
adequate according to 21% of mothers, 71% found it irregular and 8% found it inadequate. Hot
meals were provided regularly in 40% of the cases, irregularly in 52% of the cases and never in
8% cases.

Regarding immunization, immunization status of the children below 2 years of age, 72% were
completely immunized according to the schedule, 28% had incomplete vaccination. Referral for
immunization and record keeping of the same was frequent in 22.33% of the cases, by others and
AWW in 64.33% of the cases and never by the AWW in 13.33% of the cases. Vitamin A
supplementation and de-worming doses (for children below 6 years) was according to the
programme in 27% of the cases, sometimes in 47% of the cases and never in 26% of the cases.

As for health checkups, growth and monitoring was done monthly in 76.5% of the cases,
irregularly in 21% of the cases and never in 2.5% of the cases.

Home visits were observed monthly in 74.67% of the cases, irregular in 23% of the cases and
never in 2.33% of the cases. Advice regarding common diseases, management and pregnancy
was given in 84% of the cases and never in 16% of the cases.

For non formal education for preschool children, facilities were regularly provided in 63% of the
cases, they were irregular in 30% of the cases and absent in only 7% cases.

Hence most of the facilities were irregular but nevertheless present.

Non satisfaction leads to low utilization of any service. Major reasons for non satisfaction in our
study were lack of regular water supply, poor quality and quantity of food and irregularity in
opening of some centers. While in a study conducted by Bhagat et al [26] the socio-demographic
profile was taken into consideration for determining the reasons for non utilization which was
found to be low educational levels, low socioeconomic levels and women married in teens and
working women who showed non utilization.

In the study conducted by Patil et al. [27], reasons for non utilization of services by mothers were
irregular supply of supplementary nutrition, household work, behaviour of Anganwadi workers,
and the beneficiaries didn’t feel the need for the services. In our study behaviour the AWW was
generally kind.

35
 SUMMARY

 Out of 90 beneficiaries who were pregnant women, majority (54.40%) were aged 19-29
years, followed by 29-39 years (28.90%) and less than 19 years (14.40%). Only 2.30%
were greater than 39 years of age.

 Regarding the educational status of the 90 beneficiaries who were pregnant women,
majority (58%) were below 10th standard, followed by H.S.L.C passed (20.00%) and
H.S passed (10%). 11% were illiterate. Only 1% was graduate and above.

 Out of 300 beneficiaries, majority (59.60%) were from nuclear families. Only 40.40%
were from joint families.

 Out of all the children aged 3-6 years, majority (59.50%) were male whereas only
40.50% were females.

 Out of 300 beneficiaries, majority (55%) were Hindu by religion, followed by Muslims
(35%) and Sikh (8%). Only 2% were Christian.

 Out of 300 beneficiaries, majority (47.33%) were from upper lower class, followed by
lower class (27.33%) and lower middle class (24.33%). Only 1% were upper middle
class. No respondents belonged to upper class.

 Out of 300 beneficiaries, majority (50%) respondents said their local AWC remained
open for more than 200 days, followed by 125-200 days (35%). Only 15% respondents
said that their local AWCs remained open for less than 125 days.

 Majority of the AWCs (50%) remained open for more than 3 hours per day, followed by
1.5-3 hours per day (33.33%). Only 16.70% were open for less than1.5 hours per day.

 Majority of the AWCs, i.e. 35% were adequately clean (>7/9 criteria) whereas 35 % were
poorly cleaned (< 5/9 criteria). Only 30% were average in cleanliness (5-7/9 criteria)

 Majority of the AWCs, i.e. 35% had water unavailable for more than 20% of days. The
percentage of AWCs having a dedicated source of water present was found to be 34%.
Only 31% of AWCs had irregular water supply.

36
 Majority of the AWCs (45%) were average (5-8/9 criteria) in terms of infrastructure and
accessibility which was followed by 30% AWCS having poor infrastructure (<5/9
criteria). Only 25% were adequate (>8/9 criteria).

 Majority of the AWCs (53.33%) had either some non functional instruments or only
some instruments were present, followed by 31% AWCs with all instruments present and
working. Only 15.67% had some instruments present of which not all were functional.

 Majority of the respondents found the behaviour of the AWWs as kind (60%), followed
by indifferent (25%). Only 15% found their behaviour harsh.

 Majority of the respondents reported that facilities in their local AWCs (64%) were
sometimes present, followed by 23% of the respondents reporting their local AWCs are
regular in their facilities. Only 13% were highly irregular.

 Majority of the AWCs (55.03%) were regular in record maintenance, followed by 31% of
the centers maintaining records most of the time. Only 2.33% were irregular.

 Majority (84%) of the respondents reported that AWWs gave advice regarding
management of common diseases and regarding pregnancy and lactation, whereas 16%
respondents reported that AWWs never gave any advice.

 Majority of the respondents got monthly home visits from the AWWs (74.67%), 23% got
irregular visits. Only 2.33% never got visits.

 Majority of the respondents reported AWWs did monthly growth monitoring (76.50%),
whereas 21% reported that the AWWs were irregular and 2.5% reported that AWWs
never did growth monitoring.

 Out of the all the child beneficiaries of 3-6yrs of age, 63% reported receiving regular non
formal education from AWWs, followed by 30% reported receiving non formal education
irregularly. Only 7% reported receiving no non formal education.

 Majority (65%) of the respondents found the quality of the food average whereas 20%
found the food good. Only 15% found it bad.

 Majority (71.67%) of the respondents found the quantity of the food irregular whereas
21.67% found the food adequate. Only 6.67% found it inadequate.

37
 Majority of the respondents (55%) said hot meals were provided most of the time for
preschool students whereas 40% said it was regular. Only 5% called it irregular.

 Majority (64.33%) of the respondents said that the referral services and immunization
record was maintained by AWW and others, 22.33% said it was frequent and 13.33%
said it was never done by the Anganwadi workers

 Majority (47%) of the below 6 year olds were given vitamin A supplementation and
deworming doses sometimes whereas 27% got it according to the program. Only 26%
never got it.

 Majority (72%) of the below 2 year olds were completely immunized and 28% had
incomplete immunization status. No respondent reported not receiving any vaccines.

38
 CONCLUSION

The response of the beneficiaries regarding the availability of the services show an
overall positive response with respect to the presence of the services as well as the ability of the
AWW to provide them; especially regarding the record keeping, maintaining immunization
status of the children, providing Non formal Education, and the home visits with growth
monitoring of the children.

However there are certain areas that have dissatisfied the beneficiaries. This especially
includes Irregularity of water availability in many centers and incomplete inventory of
instruments and toys for children. There was also a mixed response with regards to cleanliness.
Only half of the responses reported regular opening of the centers and up to desired time period.
This suggests subpar management by the AWW. AWW themselves, although of good behavior
and maintain a regular record keeping, falls short on providing services like Take away ration
regularly, giving advice regarding common diseases, referral services, and explaining the
important aspects to pregnant females.

The quality of nutritional services is average and is due to the irregularity in the
availability of supplies.

A lack of registered Adolescent females and high irregularity in the services provided to
them was observed which can be attributed to the lack of spread of knowledge amongst the
general population regarding presence of services for them.

39
 RECOMMENDATIONS

• General awareness through electronic and print media regarding the services provided by
ICDS to the general public, especially for the adolescent females and low socio economic
status families.

• Time to time study for follow up on the improvement of the services provided.

• Provisions of regular supply of food items, essential medications, stationary items to

regularize the delivery of services by the government.

40
Annexure
 BIBLIOGRAPHY

1) Handbook of Anganwadi workers, published by National Institute of Public Corporation and

Child Development (NIPCCD), New Delhi.

2) Directorate of social welfare (women and child development sector):

https//menandchildren.assam.gov.in/portlet-innerpage/icds

3) Park K. Parks Textbook of Social and Preventive Medicine, 25th edition. Publisher-Bhanot

4) Ahmad E, Khan Z, Khalique N et al: A study of utilization of ICDS in 1-5 years old children
registered with rural health training centre, Jawan, Aligarh, UP. Indian journal of preventive
and social medicine (2005); 36(34): 137-42.

5) Sheikh Mohd. Saleem, Modified Kuppuswamy Socioeconomic Scale, 2019

6) Surwade JB, Mantri SB, Wadagale AB: Utilisation of ICDS scheme in urban and rural area
of Latur district with special reference to paediatric beneficiaries, 2012. International journal of
Recent trends in Science and technology (2013); 5(3): 107-110.

7) Saha M, Biswas R: An assessment of facilities and activities under Integrated Child

development services in a city of Darjeeling district, WB, India. International Journal of
Community Medicine and Public Health (2017); 4(6): 2000-2006.

8) Biswas AB, Das DK, Roy RN, Saha I, Shrivastava P, Mitra K: Awareness and perception of
mothers about functioning and different services of ICDS in 2 districts of West Bengal. Indian
Journal of Public Health (2010); 54(1): 33-35.

9) Sharma M, Soni GP, Sharma N: A validation study for services provided by Anganwadi
centers in Raipur City, April-June 2013. National Journal of Community Medicine (2013); 4
(2): 361-366.

10) Dandotiya D, Priya A, Joppo M, Melwani V, Sethia S: A study on utilisation and satisfaction
of ICDS services in Anganwadi of Urban Bhopal. Indian Journal of Youth and Adolescent
Health (2017); 5(1): 1-4.

11) Sivanesan S, Kumar A, Kulkarni MM, Vaneath A, Shetty A: Utilisation of ICDS scheme by
child beneficiaries in coastal Karnataka, India. Indian journal of Community Health (2016);
28(02): 132-138.

[1]
12) Patni MM, Kavishwar A, Momin MH, Kanthria SL: A cross sectional study to understand
the factors affecting intake of supplementary nutrition among children registered with ICDS
Anganwadis. Natl J Community Med (2013); 4(1): 59-64.

13) Ministry of women and child development, Govt. of India, User's manual for filling up of
AWC registers/reports and tools of AWWs, November 2012.

14) Ministry of women and child development, Govt. of India, Operational Guidelines for food
safety and hygiene for supplementary nutrition under ICDS, December 24.

15) Mahatma Gandhi NREGA Division, Department of Rural Development, Ministry of Rural
development, Govt of India, Guidelines for construction on Anganwadi Centers, August 2015.

16) Ram PV, Dasgupta A, Pal J, Parthasarathi R, Biswas R, Naiya SA: A cross sectional study on
client satisfaction of Anganwadi workers under Integrated Child Development Services (ICDS)
scheme in a slum of Kolkata. Natl J Community Med. (2014); 5(1):88-92.

17) Gjosten DK. Negotiating conflicting roles: female community health Workers in rural
Rajasthan –a perspective on Indian Anganwadi Programme. University of Oslo (2012).

18)Awefeso N, Rammohan A: Three decades of Integrated Child development Service

Programme in India; Progress and Problems. Discipline of Economics, School of Business,
University of Western Australia, Annual Publication (2011): 243-58.

19) Rani PU: ICDS- a study of job performance of supervisors and care workers. Journal of
pediatrics (2010);2.

20) Yadav K, Verma A: Perspectives and Policies- a study of care workers. Journal of
pediatrics (2010);2.

21) Kapil UK, Gaur DR, Sood AK: Nutritional beliefs among Anganwadi workers. Indian J
Pediatr (1992); 29(1): 67-71.

22) Daga SR, Daga AS, Dighole RV et al: Anganwadi worker’s participation in rural Newborn
care. Indian J Pediatr (1993); 60(627).

23)Udani RH, Chothani S, Arora S, Kulkarni CS. Evaluation of knowledge and efficiency of
Anganwadi workers. Indian J Pediatr (1980); 47(387): 289-92.

24) Udani RH, Patel RB: Impact of knowledge of Anganwadi workers on Slum community.
Indian J Pediatr (1983); 50(403): 157-9.

25) Kant L, Gupta, A & Mehta, SP: Profile of Anganwadi Workers and their knowledge about
ICDS. Indian J Pediatr (1984); 51: 401.

[2]
26) Bhagat VM, Choudhuri SG, Baviskar SR etal: Availability and utilisation of Anganwadi
services in an adopted urban area of Wardha. Online J Health Allied Scs 2015; 14(4): 4.

27) Patil KS, Kulkarni MV: Knowledge and utilisation of ICDS scheme among women in an
urban slum- a community based study. Indian Journal of Forensic and community medicine 2016
Oct; 3(4): 267-71.

[3]
 PROFORMA

Section A: General Information

Particulars of the subject:

Name:

Age:

Sex:

Address: Ward/Village:

Educational Status:

Occupational Status:

Source of info:

Particulars of the AWC:

Address of AWC:

1st date of registration in AWC:

Particulars of Head of Family:

Name: Age: Sex: Occupation:

Education status: Relation to the subject:

Total Monthly income of the family:

Socioeconomic Status (According to KUPPUSWAMY scale 2019):

Family Composition:

S.no Name Relation Age Sex Marital Education Occupation Remarks

with status status status
head

[4]
Section B: AWC: General

Q. How many members of the family is availing ICDS facility in the family?

Satisfactory: All eligible Average: Not all who are eligible Poor: If more than one
are eligible and only the participant is availing

Q. Is the AWC regularly open?

Satisfactory: Greater or equal to 200d Average:125-200d Poor: Less than 125d

Q. How many hours per day is the AWC open?

Satisfactory: Greater than 3hrs Average: 1.5 to 3hrs Poor: Less than 1.5 hrs

Q. How clean are the AWC?

Adequate (7 or more out of 9 points) Average (5-7 out of 9 points) Poor (less than 5 out of 9
points)

Criteria for cleanliness:

• Premises should be cleaned everyday and not during food preparation

• Dedicated cleaner present

• Sanitary toilet and washed everyday

• Clean kitchen with its utensils

• Safe disposal of stool and waste

• Pest control especially of storage of food stuff

• Personal cleanliness and behaviour maintained like hand washing

• Storage of pesticides fuels etc away from food

• Soap availability

Q. Is water available in adequate amounts in AWC?

Satisfactory: Dedicated source present Average: Irregular availability of water Poor: More
than 20 percent of days not available

Q. How is the behaviour of the AWW with the subject?

Satisfactory: Kind Average: Indifferent Poor: Harsh

[5]
Q. Whether all the facilities of the ICDS given by the AWC on time?

Satisfactory: Frequently Average: Sometimes Poor: Never

Q. How is the Infrastructure and accessibility of the AWC?

Satisfactory (8 or more points out of 10) Average: (5-8 points out of 10)

Poor (less than 5 points out of 10)

Criteria for adequate infrastructure:

• Pucca/semipucca building

• Allotted building

• Spacious

• Well ventilated

• Windows with wire mesh of adequate amount

• Kitchen separate from activity room

• Separate storage facility with locks

• Adequate lighting

• Availability of electricity

• Filtration availability for water

Q. Are all the instruments required for proper functioning present in the AWC?

Satisfactory: All present and working Average: All present but some non functional or not all
present but functional Poor: Some present and of which some are non functional.

Q. Whether the AWW maintains details on records on every AWC visit?

Satisfactory: Regular Average: Most of the time Poor: Irregular

[6]
Section C: Nutritional Supplementation

Everyone:

Q. How is the quality of the food?

Good: (5 or more out of 7 points) Average: (3-5 out of 7 points) Poor: (less than 3 out of 7
points)

Criteria for quality:

• Assured quality of cereals (FCI godown) and other staples (Agmark, ISI etc)

• Unadulterated

• Uninfected

• Fresh fruit and vegetable

• Fresh eggs

• Records regarding foodstuff purchase being maintained

• Proper storage of foodstuff away from toilet and pesticides and other hazardous material
and pest free.

Q. How is the quantity of the food?

Satisfactory: Adequate Average: Irregular Poor: Inadequate most of the time

Children 3to6 yrs:

Q. Whether hot meals/ snacks provided to children less than 6yrs at AWC?

Satisfactory: Regularly Average: Irregularly Poor: Never

Section D: Health and Nutritional Education and Checkups

Everyone:

Q. Whether home visit is done by AWW? (Except teenage girls)

Satisfactory: Regularly (monthly more than or equal to 1 time) Average: Irregular

Poor: Never

Q. Whether they informed about common diseases and management?

Satisfactory: Adequately Average: Sometimes Poor: Never

[7]
Q. whether VHND performed in the AWC?

Satisfactory: Regularly (monthly) Average: Sometimes Poor: Never

Q. Whether IFA supplementation given (According to age and deworming dose)

Satisfactory: Regularly Average: Sometimes Poor: Never

Q. Whether they were referred to higher centers on detection of serious disease?

Satisfactory: Yes Average: Sometimes by AWW Poor: Never by

AWW

Antenatal Postnatal and Nursing Women:

Q. Whether the subject was encouraged to go to the ANC?

Satisfactory: Frequently Average: By others and AWW Poor: Never by

AWW

Q. Whether Advice regarding pregnancy, danger signs, breastfeeding, common conditions,

diseases, MCP card etc was given?

Satisfactory: Adequately Average: Sometimes Poor: Never

Children 3 to 6 yrs:

Q. Whether physical examination done or not to the child (weight especially)?

Satisfactory: Frequently (with every visit to AWC and home visit) Average: Irregularly
Poor: Never

Q. Whether milestones were recorded of the child?

Satisfactory: Frequently Average: Sometimes Poor: Never

Q. Whether Vitamin A supplementation and de-worming dose given to the child?

Satisfactory: According to program Average: Sometimes Poor: Never

SECTION E: Immunization

Q. Whether the subject was referred to nearby health centers for immunization?

Satisfactory: Frequently Average: By others and AWW Poor: Never by AWW

Q. Immunization status of the subject

(Antenatal postnatal nursing women: TT dose; Others: according to schedule)

[8]
Satisfactory: Completely immunized Average: Incompletely immunized

Poor: Not immunized

Section F: Non Formal Education

Q. Whether Facilities for the same is present of not?

Present Absent

Q. Whether the facilities are regular or not?

Satisfactory: Regular Average: Most of the time Poor: Irregular

Q. Whether school/ stationary items/ toys given and of what quality?

Satisfactory: Given and of good quality; Average: Acceptable quality; Poor: Not given or of
poor quality.

[9]
 LIST OF ABBREVIATIONS

 ANC- Ante Natal Checkups

 MCP- Mother and Child Protection Card

 IFA- Iron and Folic Acid tablets

 VHND- Village Health and Nutrition Day

 AWC- Anganwadi centers

 AWW- Anganwadi Workers

 ICDS- Integrated Child Development Services scheme

[10]
 GANTT CHART OF THE STUDY:

Allocation of

Project and

discussion.

Review of

literature.

Proforma
preparation.

Data Collection

Analyzing Data

Interpretation and

evaluation.

MONTHS - Apr May Jun Jul Aug Sep Oct Nov

[11]
IMAGE GALLERY

[12]