Frontline
Volume 22 - Issue 12, Jun 04 - 17, 2005
The unsung heroines of India
Jayati Ghosh
Underpaid and overworked anganwadi workers are the real providers of
many basic services for the poor across India. Improving their wages
and working conditions is the need of the hour.
AKHILESH KUMAR
Anganwadi volunteers of Chhattisgarh taking out a rally demanding a
hike in their honorarium, in Raipur on April 13.
THE appalling and brutal attack in Madhya Pradesh recently on a woman
anganwadi worker who was assisting a government campaign against
child marriage ought to have served to highlight the huge
contribution made by such workers in general in the face of terrible
conditions. Unfortunately, we live in a callous and ungrateful
society, where those who make the most positive contribution are not
only unsung but also left unprotected against all sorts of violence.
In the long and mostly depressing chronicle of living conditions of
the majority of the Indian population, there are still some instances
of minor successes. Some of these successes result rather directly
from the process of what is broadly called "development", such as the
expansion of basic infrastructure, the extension of some public
services and the like. But, these processes have a more particular
micro aspect in terms of the people who are actually providing the
most important public services.
Among the most critical of such services are those related to health,
nutrition and basic sanitation. These are not simply determined by
the public programmes directed towards them, but are probably more
affected by macro policies and processes which affect food security,
employment and income generation possibilities, and so on.
Nevertheless, some of the programmes do play important roles.
Of course, progress in these areas is still far from adequate, and
the slow spread and unsteady improvement of such services is a major
indictment of the development process thus far. Further, the economic
policies of the past one and a half decades have had adverse impact
on many such conditions by reducing the levels of crucial public
expenditure in these areas and removing important forms of public
protection.
Nevertheless, there are signs of some hope, particularly among the
most destitute groups. These are expressed most clearly in the
significant declines in the number of severely malnourished and
moderately malnourished children and the infant mortality rates (IMR)
in the country. According to National Family Health Surveys (NFHS),
the percentage of children suffering from severe malnutrition
declined from 15.3 per cent during 1976-78 to 8.7 per cent during
1988-90. IMR declined from 94 per 1,000 live births in 1981 to 73 in
1994. Subsequently, IMRs have stagnated in most parts of the country
and average levels of nutrition remain poor and may even have
worsened. But the evidence is that severe undernutrition continues to
decline.
What explains the areas of progress and the contradictory features of
the recent past? One important factor is the role of one of the
largest schemes of the Government of India, which relies dominantly
on poorly paid and overworked women workers to provide some of the
most essential public services in the area of health and nutrition.
This is through the Integrated Child Development Scheme (ICDS), which
was initiated nearly 30 years ago in October 1975 in response to the
evident problems of persistent hunger and malnutrition especially
among children. Since then, the ICDS has grown to become the world's
largest early child development programme.
The coverage of the scheme has expanded rapidly, especially in recent
years. From an initial 33 blocks in 1975, the programme covered an
estimated 6,500 blocks by 2004. There are almost 600,000 anganwadi
workers and an almost equal number of anganwadi helpers - all women -
providing services to beneficiaries throughout the country. According
to the government, the programme currently reaches 33.2 million
children and 6.2 million pregnant and lactating women.
The ICDS involves the setting up of anganwadi centres, each of which
is intended to cater to a population of around 1,000 in rural and
urban areas and to around 700 in tribal areas. The anganwadi worker
and helper, who are the basic functionaries of the ICDS, are not
treated on a par with other government employees, but are called
"social workers" or "voluntary workers". They are not paid "wages"
(which would provide them with some minimum service conditions) but
only an "honorarium", which was until recently only Rs.1,000 a month
for the worker and Rs.500 for the helper. Even now anganwadi workers
do not get more than Rs.2,000 a month in any State.
Despite this very low remuneration, the activities these workers and
helpers are required to perform are very extensive. Each anganwadi is
meant to provide supplementary nutrition to the children below six
years of age, and nursing and pregnant mothers from low income
families and immunisation of all children less than six years of age
and immunisation against tetanus for all the expectant mothers.
The anganwadi workers are to provide nutrition and health education
to all women in the age group of 15-45 years, as well as basic health
check-up, which includes antenatal care of expectant mothers,
postnatal care of nursing mothers, care of newborn babies and care of
all children under six years of age. They are supposed to be able to
refer serious cases of malnutrition or illness to hospitals,
Community Health Services (CHS) or district hospitals. In addition,
the same two workers on their own are to provide non-formal
pre-school education to children in the three to five age group.
For all of these, not only are the wages paid to the workers and
helper low, but the other resources and facilities provided for
undertaking all this work are minimal. Nevertheless, by most
accounts, thus far the scheme has been a success, and is counted
among the more effective of government programmes. Most studies
conducted on the functioning of the ICDS have recognised its positive
role in the reduction of infant mortality rate, in improving
immunisation rates, in increasing school enrolment and reducing the
school dropout rates.
Nevertheless, it is also clear that for a scheme that has been in
operation for three decades, the benefits are still far too limited,
and maternal and child health and nutrition are still areas of major
concern for policy. Even today, around one-third of Indian children -
and more than half in rural areas - are born with low birth-weight.
More than 30 per cent of children under five years are severely
stunted, and around 20 per cent are severely underweight. These
indicators are particularly bad in some ostensibly more "developed"
and relatively high-income States such as Gujarat, Maharashtra and
Karnataka.
The high incidence of premature births, low birth-weight and neonatal
and infant mortality can be attributed to poor nutritional conditions
of the mothers. The majority of women still do not get proper
nutrition and health care during their pregnancy. In some areas,
60-75 per cent of pregnant women receive no antenatal care at all.
More than 85 per cent of women in rural areas and 95 per cent in the
remote areas give birth at home. Only 42 per cent of women in the
country have access to safe delivery facilities. Surveys indicate
that even the immunisation services are still less than desired:
around 30 per cent of children in the age group of one to two are not
adequately immunised.
The main reason for this continuing dismal picture even after 30
years of the ICDS is that not enough resources have been devoted to
this scheme to meet the huge requirement. Quite simply, there are not
enough anganwadis or anganwadi workers, and they do not have adequate
resources to meet all the nutritional requirements of those pregnant
and lactating mothers, infants and small children who need them. If
the declared norm of one anganwadi per 1,000 population is to be met,
there should be 14 lakh anganwadis, as against the current 6.5 lakh
such centres, of which only around 6 lakh centres are operational.
There is the further problem of overloading the tasks assigned to
anganwadi workers. The worker and helper in such centres who receive
the paltry "honorarium" are seen as "part-time workers" in the
centres that are supposed to open for only four hours a day. Yet,
they have been found to be among the most dedicated and committed of
public servants who have developed grassroots contacts and are able
to identify particular individuals and groups in any community
easily. They are, therefore, increasingly engaged in a wide range of
other public interventions, especially in rural areas, including
health mobilisation, total literacy and education programmes. They
are called upon to help in election duties, to assist in other public
programmes as and when the State or local governments require them.
The fact that the woman who was attacked in Madhya Pradesh was
involved in a public campaign against child marriage is proof of this.
All this amounts to much more than a full-time activity, yet the
anganwadi workers and helpers are hardly compensated for all this. In
any case there are simply not enough of them to cater to all of these
varied demands even within a small population. The obvious need,
therefore, is to increase the number of such workers and to provide
them with higher wages that would reflect all the work that they
really do perform. In addition, of course, they simply must be
provided with the minimum wherewithal required to perform these
services in a satisfactory manner.
There are other problems that stem directly from this inadequacy of
centres, staff and resources to run this programme effectively. It
has been found that one of the primary reasons for poor coverage of
needy groups under the scheme is the location of the anganwadi
centre, which typically tends to be in the main village or in "upper"
or dominant caste hamlets in rural areas in most States. This
restricts the access to such services by deprived communities such as
the Scheduled Castes and Scheduled Tribes, which are precisely the
groups who require it the most.
There are frequent complaints of the delay in Central government
transfer of resources for this programme, while State governments
differ substantially in the amount and quality of supplementary
nutrition that is provided. This makes the scheme uneven and
sometimes even problematic in terms of the quality of food provided
and its acceptability to small children. Also, the way the programme
has been implemented, it effectively ends up concentrating mainly on
the three to six age group. There are no facilities to allow for
reaching out to such children and their mothers at home in an
effective way.
The working hours of the anganwadi centres also effectively keep out
many of the poorest households; they are open only for four hours a
day. When both parents are working, which is typically the case among
rural labour households in many parts of the country, it is difficult
to deliver and pick up the child from the centre in time, and so
children in such households get excluded from the services. Once
again this really boils down to a question of resources, since these
centres should be open for longer durations with higher associated
expenditure.
But then this would require a change not only in the level of
resources provided for these activities, but also a change in the
mindset of the government, which still treats the anganwadi workers
and helpers as less than full workers even while making more than
full use of their services. If we as a society truly value those who
are making this crucial input towards the future, then there should
be much greater public outcry over the wages and working conditions
of the anganwadi workers, and also greater public demands for the
rapid and effective expansion of the ICDS.
_________________________________
Labour Notes South Asia (LNSA):
An informal archive and mailing list for trade
unionists and labour activists based in or
working on South asia.
LNSA Mailing List:
Labour Notes South Asia
To subscribe send a blank message to:
<[EMAIL PROTECTED]>
LNSA Web site:
groups.yahoo.com/group/lnsa/
Run by The South Asia Citizens Web
www.sacw.net
_________________________________
To join the Labour Notes South Asia Mailing List, send a blank message to:
[EMAIL PROTECTED]
To Unsubscribe, send a blank message to: [EMAIL PROTECTED]
Yahoo! Groups Links
<*> To visit your group on the web, go to:
http://groups.yahoo.com/group/lnsa/
<*> To unsubscribe from this group, send an email to:
[EMAIL PROTECTED]
<*> Your use of Yahoo! Groups is subject to:
http://docs.yahoo.com/info/terms/
