Implementing a “convergent” framework of action against childhood malnutrition in urban informal settlements of Mumbai

Abstract

Context: The National Nutrition Mission (POSHAN Abhiyaan) intends to “converge” nutrition-related program components across sectors (nutrition, health, water, and sanitation). In this study, we have examined the perspectives of Anganwadi workers (AWWs), the frontline workers of the Integrated Child Development Services, on working in convergence with the public health sector. Methods: This exploratory qualitative study was done between June 2018 and June 2019 in two urban informal settlements in Mumbai. We conducted in-depth interviews with 26 AWWs and their supervisors, purposively sampled and diversified in terms of age, education, and years of experience. We used the software NVivo version 12 to aid analysis. Results: Most AWWs acknowledged that a convergent framework of action between “nutrition” and “health” was likely to be beneficial to the community. However, they also shared that cross-sector convergence was currently limited due to technical unfamiliarity with “health-sector” issues in the frontline, discomfort with data sharing, and lack of meaningful incentives for joint work. Broader organizational challenges such as poor infrastructure and lack of supervision, as well as challenges in the urban context (migration and cultural barriers) further hindered joint activities. Conclusions: The findings indicate that critical structural gaps in the urban setup of ICDS need to be addressed and AWWs need to be better familiarized with the changing roles expected from them under POSHAN Abhiyaan . To work better with the health sector, the work timings of AWWs need to be aligned with those of the health sector and meaningful financial incentives need to be put in place for cross-sector activities.

Role of civil society in health care: Mechanisms for realizing universal health coverage in vulnerable communities of India

“…Over the years SNEHA has built strong partnerships with public systems such as the Integrated Child Development Services (ICDS) and Municipal Corporation of Greater Mumbai. However, there are real-world challenges in operationalizing cross-sector convergence which could have implications for the provision of primary health care (30). An indepth study on perspectives and experiences of this collaboration indicated that effort goes into establishing and sustaining personal relationships with staff working in the public system, building trust, training their staff from time to time, disseminating information on public sector schemes, support in conducting routine activities including community mobilization, referrals, data collection and sharing which helps in improving service provision and connecting the services to the community members (31).…”