Factors associated with Anganwadi Workers’ service delivery of Integrated Child Development Services (ICDS) in rural India: A cross-sectional analysis of household and community health worker surveys

Objectives: India’s 1.4 million Anganwadi Workers (AWW), a type of community health worker (CHW), serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) program. They play a crucial role in facilitating the delivery of nutrition services at the village level in India. Despite this, quantitative evidence regarding the factors that influence the service delivery of AWW in India is limited. Methods: We used data from 6653 mothers of children below 12 months, 2398 pregnant women, and 1344 AWW from 841 villages in Bihar and Madhya Pradesh collected in 2018-19. AWW performance was operationalized as product-oriented services, such as growth monitoring and supplementary food, and information-oriented services, such as the number of home visits and counseling on infant and young child feeding practices (IYCF). We fitted multivariate logistic regression models for each outcome using a set of AWW variables, applying the Means, Motives, and Opportunity (MMO) framework: means (AWW capabilities, including education and experience), motives (AWW willingness to perform, including motivation and supervision), and opportunities (AWW chance to perform, including training, AWW caste, and workload). Results: Regarding product-oriented services, approximately 48% of beneficiaries received growth monitoring services, 52% of women received take-home rations, and 20% received hot-cooked meals. Regarding information-oriented service delivery, more than a third (37%) received home visits, and 45% of women got counseling on IYCF. Opportunity-related factors such as AWW caste, training, and availability of facilities and resources were significantly associated with the receipt of product-oriented services. For information-oriented services, motives and opportunity-related factors were significantly associated, including motivation, timely salary receipt, AWW caste, supervision, and training. Conclusion: Harnessing CHWs’ skills and performance could address healthcare system challenges, extend program reach, and accelerate progress toward Universal Health Coverage. Our research underscored the importance of factors such as training, access to resources, and service delivery of AWW. Trial registration number: https://doi.org/10.1186/ISRCTN83902145.