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Fighting Covid-19 on frontline equipped only with commitment, burden of expectations

Meera Chaudhary
By Moin Qazi*
During my professional engagement with rural India, I found that one of the most useful resources at the grassroots level is an anganwadi worker. I would always begin my village exploration with a visit to her and would be rewarded with a finer introduction to the local community. I have always regarded anganwadi workers as the most efficient last-mile connects and delivery on the ground that is both devoted and empathetic. 
An anganwadi worker whom I have known for most of my professional life and who is still active in that role is Meera Chaudhary of Wanoja village in Chandrapur district in central India.
In normal times, India’s million plus army of anganwadi workers is on the frontlines of the country’s war against undernutrition. Anganwadis are the primary units of Integrated Child Development Services, (ICDS), and the world’s largest state promoted social programme. ICDS was launched on October 2, 1975, with about 5,000 anganwadis.
The centres are tasked with a range of public health responsibilities including providing supplementary nutrition for children under the age of six, pregnant women, and nursing mothers, teaching mothers about child nutrition, and give pre-formal school education, and undertaking immunization, health check-ups, and referral services for this population
Today, it has joined another battle -- the battle against Covid-19. This vast cohort is now at the forefront of community surveillance, detection, and prevention mechanisms, going door to door, recording people’s travel history, noting symptoms, advising people of hygiene protocols and social distancing to protect themselves against the virus.
They form an important part of the disease surveillance and mitigation mechanism. Since they know their people well, and have intimate on-the-ground experience, this legion of anganwadi workers is extensively used by district administrations in times of crisis. Dealing with emergencies is therefore not alien to their cadre.
Anganwadi workers are a resilient workforce and can adapt very quickly to difficult circumstances. Like her peers, Meerabai is leading Covid work in Wanoja village. Apart from spreading awareness about the coronavirus and conducting related surveys, she visits houses, looking for cases of cholera and keeping track of immunization, family planning, nutrition etc.
An anganwadi worker is usually is a local village woman, between 18 to 35 years of age and educated up to grade X. She gets paid around Rs 4,000 per month. I remember vividly my first encounter with Meerabai. She lived in a primitive house which had a very low entrance. I had to bend almost half to get into it. Meerabai had a goat which she milked on every visit to prepare tea for us. We became regular visitors and she always welcomed us with great warmth. We would spend time discussing local affairs, the diverse occupations and even politics although Meerabai had little interest in it. Since Meerabai was the primary interface of the village for development staff of the government, she was familiar with the niceties to be done when entertaining visiting dignitaries. I found her a well trained host.
Meera's husband Vasantrao had a hair salon in the local town. When Meerabai became anganwadi worker in 1986 she received a monthly compensation of Rs 125. For Meerabai the job was purely a labour of love. Although anganwadis were the primary units of India's mainstream nutrition programme for women and children, anganwadi work was considered more of a social contract than a source of stable income.
Meerabai's organising skills and her endearment to her people proved highly resourceful to us. She would host our meetings in her house and whenever the meetings were larger, she would open the anganwadi premises. While the anganwadi was not part of our agenda, we got involved in it for Meerabai’s sake. We helped the anganwadi with a small donation which for purchasing an audio player, a few tricycles and a collection of modern toys.
I have known Meerabai for over almost thirty years and I have been both amazed and astonished by the consistency of her calm and cool bearing. Anyone who has closely observed her affirms she has not changed even a bit. During the early career also she carried an air of seriousness around every task she undertook.
This is the reason she was never allowed to retreat to the privacy of her home even when she was keen to take a final holiday. She juggled the anganwadi job even as she saw through the education and marriages of her three daughters, Archana, Aarti and Bharati.
She saw several juniors join and leave the anganwadi on account of lack of adequate monetary incentives. But she couldn’t think of a reprieve because parents would shudder at the very thought of what the anganwadi would be like without Meerabai.
Despite all the hard work Meerabai retains a wiry and sturdy frame with not an inch of extra flesh on her body even as she springs to and fro between her home and anganwadi. Meerabai has grown into a versatile resource primarily because she has handled practically every grassroots role for which there was no specifically assigned government worker.
Meerabai is leading Covid work in Wanoja village. She spreads awareness about the coronavirus pandemic and conducts related surveys, visiting individual houses
There was a time when the block administration wanted to use self help groups for promoting its nutrition mission for children and pregnant mothers. We already had these groups for microfinance. Meerabai provided us a platform for using them as conduits for social and financial programmes.
How is it that when every anganwadi gets the same monthly support from the government, some perform well while others lag behind. One major reason is leakage at every level where the aid is sponged off. As the aid travels only a small part reaches the actual beneficiary. Indians have learnt to live with this so called ‘chalta hai’ attitude.
But you will get a better answer when you observe a typical day in Meerabai's work schedule. Meerabai is meticulous about hygiene and the quality of raw materials used for cooking mid-day meals for children. She pays attention to every minute detail so that the overall ambience of anganwadi is highly stimulating.
The children belong to a very sensitive age band (under six years) when their vital cognitive and behavioural functions are being developed .Meerabai's deep understanding of child behaviour has made a huge difference.
A child’s early years have a disproportionate impact on the rest of their social, mental and emotional lives and impact adult behavior, learning, and mental health. That’s why anganwadis are considered a cost-effective way to raise a generation of healthy, socially adept and productive adults. It is far better than keep repairing sick adults later.
Anganwadi workers do not have any comprehensive manual on managing their role. They are taught broad principles and it is left to their raw native understanding and native wisdom to flesh out the details. An anganwadi worker is entrusted with many non-ICDS tasks – such as preparing voter IDs, conducting census, employment or Swachh Bharat Mission (Clean India Mission) surveys and helming election booths–none of which is paid work except for election duty.
Despite the key role they play in combating India’s health crises, anganwadi workers do not have regular salaries, partly because their work is supposed to be voluntary and part-time. Most, however, end up working full-time due to the demands in their communities. They receive around Rs 5,000 a month.
It may not be possible for the government to provide formal salaries and other allowances to anganwadi workers on account of the country’s experience with formal employment. But it can give frontline responders such as health workers and social service providers guaranteed support and fair compensation.
Many of these health workers fighting the Covid-19 on the front lines are equipped only with commitment, courage, and the burden of expectations. One way of improving motivational levels of anganwadi workers is through aligning their incentives with policymakers’ objectives.
Each anganwadi worker can be individually responsible for services at her centre, thereby avoiding the problems associated with free-ridership .Payment would be made based on overall outcomes among all the children at each center, incentivizing each worker to allocate efforts among tasks in somewhat the same way as payments to teachers for education outcomes are based on improved test scores.
Focusing on outcomes creates incentives for workers to employ contextual knowledge about the optimal allocation of available resources .performance pay in the health sector usually targets the provision of intermediate inputs such as clinic visits or other specific services .
Meerabai recalls the hardship she endured in setting up the anganwadi and the tough ordeals during the family planning programme when stiff targets had to be met for sterilizations. She recalls how “scary” it was when her inexperience landed the initial efforts in trouble, but her bosses rallied around and chipped in.
Anganwadis continue to be the backbone of India’s grassroots social services platform for women and children. However the real value of the programme can be realized only through when the cadre has devoted workers like Meerabai. They are the most authentic mascots of this mission which would complete a half century in a few years.
---
*Development expert

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