As I stated at the start of this thesis, understanding how AWWs negotiate existing limitations within their low resource settings and emerging opportunities offered by technology remained as my personal and academic motivation. By pursuing this motivation, I intend to draw implications from the thesis findings to contribute towards intensifying supporting AWWs’ battle against child undernutrition especially in a context like Bihar. The overall findings of this thesis suggest the following implications for policy and practice at the state and national contexts: To enable the AWWs to fight against child undernutrition, firstly, the state and national governments should significantly focus on improving the work environment of AWWs. The
resource limitation and inadequate monetary incentives seem to be a recurring theme in studies that examined performance of workers like the AWWs. Every single study that explored the ICDS identified limited resources and inadequate monetary incentives for AWWs as hindering factors of the implementation of the programme. This thesis also confirms that work environment factors such as workload, incentives, supervision, and resources limit an AWW’s motivation and performance. Although they continue to work due to income needs, in order to maximise their effort and performance, it would be crucial to address the root of their demotivation which is their income needs. As with the majority of studies on the ICDS, this thesis also confirms the severe resource gaps which exist for the AWWs and the service more generally. More importantly, the thesis clearly demonstrates how this gap hampers the relationship of the AWW and the community when the AWW does not have the resources to provide services to everyone. This relationship is shaped by caste dynamics, seasonal migration, and perceptions of corruption. In the context of Bihar, the resource gap and targeting of beneficiaries further complicates the AWW and community relationship leading to incidents of physical violence and closure of services. Hence, addressing the financial motives of the AWWs and providing them adequate programmatic means to deliver their work not only remain crucial in their performance but in ensuring basic provision of health and nutrition services at the village level.
Secondly, other than highlighting the income needs of an AWW, this thesis also contributes towards understanding the identity clash AWWs continue to feel against the programme expectations of them. They do not perceive themselves as honorary workers and continue to raise their demands for a minimum wage for their job. They also self-identify as preschool teachers more than as nutrition workers. Although a few studies on the ICDS mentioned the identity clashes AWWs feel, the majority of the studies only marked the lack of monetary incentives and role clarity without exploring the identity clashes behind it. Addressing the identity of the AWW by aligning the workers’ and programme expectation is surely needed to achieve programme goals.
Thirdly, the findings of this thesis suggest that even for the AWW to make the range of health and nutrition service accessible with adequate quality, beneficiary preferences matter. To intensify the efforts to reduce child undernutrition, either the service basket needs to take the beneficiary preference for the product-oriented services into account or enable AWWs by providing them local levers to satisfy the product need of the beneficiary.
Finally, the technology intervention studied in this thesis suggests that a technology intervention alone could not improve service delivery at the AWW level or at the household level because it did not overcome beneficiary and AWW preferences against information-oriented nutrition
services. The incentive component of the technology augmented intervention missed the opportunity to satisfy the income needs of the AWWs. However, technology seems to be useful when combined with the widely tested model of cash transfers for beneficiaries. Hence, in reducing child undernutrition, technology interventions coupled with interventions to engage beneficiaries would be more beneficial than just an intervention at the AWW level to improve her performance.
Other than the above mentioned broader policy implications, the findings of this thesis suggest a few Bihar specific policy and practice implications.
The ICDS services, especially food distribution, are universal across the rest of India. Bihar remains as the only state that practices targeting of beneficiaries (Kosec et al., 2015). The findings from this thesis suggests that the targeting not only hampers the AWW’s service specific performance, but it also hampers her community relationships. The relationships shaped by caste, seasonality induced migratory patterns, and the perception of beneficiary preference towards products put strain on the AWW. Although the food distribution poses a multitude of challenges, the perception of beneficiary preference for products suggest that the AWWs will continue to need tangible products (food or non-food) to sustain beneficiary interest.
The research findings suggest that the seasonal migratory patterns of low-income families to brick kilns and elsewhere hampers AWW performance. This happens due to the strict targeting of resources at the AWC level. However, this finding also implies that the low-income families - especially those belonging to lower caste groups - seem to miss out the health and nutrition services while they migrate out. The interviews with the AWWs also suggest that these groups often need the services the most. Due to their migration, they stop receiving services from their villages and the strict catchment area demarcations prohibits them from accessing services from AWCs near the brick kilns. Considering these households continue to experience poor standard of living and limited access to health systems, the state government needs to invest in concentrated efforts towards improving their lives. To better link them to AWC services, these families can be catered to using a mobile AWC services or make provisions for them to register in AWCs near their workplaces.