Determinants of Community Health Workers’ Performance in India

Abstract

Forty-three anganwadi workers (community health workers) in Gujarat state, India, were interviewed to record their education level, evaluate their nutrition knowledge, and collect information on the number of visits made by the auxiliary nurse midwife (ANM) in the preceding three months and the activities she performed for the anganwadi. The coverage of five services delivered or assisted by the anganwadi worker- supplementary feeding growth monitoring, vitamin A prophylaxis, health checkups, and immunization- was estimated by interviewing the mothers of 3,987 children 0–6 years old. The anganwadi worker's having at least a high school education, a nutrition knowledge score of more than 4 out of 7, more than one visit by the ANM in three months, and an ANM activity score of more than 2 out of 9 were significant determinants, individually or in combination, for the anganwadi worker's performance. Multiple regression analysis indicated that nutrition knowledge was the most powerful determinant of performance, followed by guidance from the ANM and education level. It is therefore concluded that anganwadi workers should receive nutrition health education and regular guidance from the ANMs, and their education level should be high school or above.