Convergence of frontline nutrition and health workers in tribal communities of Maharashtra: a cross-sectional mixed-methods study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20254056Keywords:
Cross-sectional study, Convergence, Nutrition interventions, Frontline workers, Scheduled tribesAbstract
Background: In India, despite decades of targeted nutrition and health programmes, progress on child malnutrition has been uneven and fragmented. Achieving sustained improvements in malnutrition requires multi-sectoral convergence at all levels. Institutionalizing convergence between ICDS and health sectors is essential to amplify the impact. POSHAN Abhiyan launched in 2018 was a landmark step towards institutionalizing convergence and amplified shared platforms like VHSND and joint collaboration between frontline workers.
Methods: This mixed-method study was conducted from November 2023 to October 2024 in two tribal dominated blocks in two districts of Maharashtra. A structured questionnaire was used to collect information about the convergence role and mechanisms among FLWs of ICDS and health department from AWWs. Focus group discussions with ASHAs and in-depth interviews with ANMs, were also conducted to understand their role and perspective on convergence between ICDS and health at the village level.
Results: Findings show the VHSND platform is routinely convened and often meets duration norms, with effective case-based collaboration for referral and high-risk follow-up. However, structured joint counselling is infrequent, joint training and supervisory visits are rare. Community governance mechanisms like VHNSCs remain largely inactive and uneven micro planning undermine service quality of nutritional interventions.
Conclusions: Policy and program actions should prioritize enforcing joint-cadre, counselling of service users and effective micro planning going beyond practical issues, institutionalizing routine cross-sector training and supervision and reactivating local governance for accountability to sustain nutrition services among marginalized communities.
Metrics
References
UNICEF, World Health Organisation, World Bank. Joint child malnutrition estimates (JME): Levels and trends in child malnutrition, 2024 edition. Geneva: UNICEF, WHO, World Bank. 2024. Available at: https://data.unicef.org/resources/jme/. Accessed on 18 September 2025.
Development Initiatives. Global Nutrition Report: The state of global nutrition. Bristol: Development Initiatives. 2021. Available at: https://global nutritionreport.org/reports/2021-global-nutrition-report/. Accessed on 18 September 2025.
Concern Worldwide, Welthungerhilfe. Global Hunger Index 2024. Bonn/Dublin: Concern Worldwide and Welthungerhilfe. 2024. Available at: https://www.globalhungerindex.org/pdf/en/2024.pdf. Accessed on 18 September 2025.
International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019-21: India. Mumbai: IIPS. 2022. Available at: https://dhsprogram.com/pubs/pdf/FR375/FR375 .pdf. Accessed on 18 September 2025.
Rekha RS, Herath C, Kumar R, Bonu S. Wealth inequalities in nutritional status among the tribal under-five children in Odisha and Jharkhand: Evidence from National Family Health Survey data. Dialog Health. 2023;8:100135. DOI: https://doi.org/10.1016/j.dialog.2023.100135
Saha-Sinha S. Convergence in nutritional interventions in India: Enablers and inhibitors. J Adv Res Soc Sci. 2025;8(2):208-26. DOI: https://doi.org/10.33422/jarss.v8i2.1441
Mohindra K, Labonte R. A systematic review of population health interventions and Scheduled Tribes in India. BMC Public Health. 2010;10:438. DOI: https://doi.org/10.1186/1471-2458-10-438
Soman B, Lathika AR, Unnikrishnan B, Shetty RS. Tracing the disparity between healthcare policy-based infrastructure and health belief-led practices: A narrative review on indigenous populations of India. J Racial Ethn Health Disparities. 2024;11(6):3572-83. DOI: https://doi.org/10.1007/s40615-023-01810-3
NITI Aayog. POSHAN Abhiyaan: Preserving Progress on Nutrition in India – In Pandemic Times. New Delhi: NITI Aayog. 2022. Available at: https://www.niti.gov.in/sites/default/files/2022-09/Poshan-Abhiyaan-Monitoring.pdf. Accessed on 18 September 2025.
World Health Organization. Multisectoral and intersectoral action for improved nutrition: Policy brief. Geneva: WHO. 2021. Available at: https://www.who.int/docs/default-source/primary-health-care-conference/multisectoral.pdf?sfvrsn =cb78cfcb_2. Accessed on 18 September 2025.
2020 Global Nutrition Report: Action on equity to end malnutrition. Bristol, UK: Development Initiatives. 2020. Available at: https://media. globalnutritionreport.org/documents/2020_Global_Nutrition_Report_2hrssKo.pdf. Accessed on 18 September 2025.
Gayithri K, Ravindran TK. Integrated Child Development Services in India – A Sub-national analysis of program implementation and intersectoral convergence. Soc Sci J. 2023;10(3):123-34.
Sachdev Y. Integrated Child Development Services (ICDS) scheme: A comprehensive approach toward early childhood development in India. Indian J Pediatr. 2011;78(7):793-9.
NITI Aayog. POSHAN Abhiyaan – The National Nutrition Mission: Progress and Implementation Status. New Delhi: NITI Aayog. 2020. Available at: https://www.niti.gov.in/sites/default/files/2020-02/POSHAN_Abhiyaan_first_progress_report_6_Feb_2019.pdf. Accessed on 18 September 2025.
Ministry of Health and Family Welfare (MoHFW). Joint guidelines for the preparation of village health sanitation and nutrition plans. New Delhi: Government of India. 2013. Available at: https://nhsrcindia.org/sites/default/files/2021-07/ Community%20Processes%20Guidelines%202014%20%28English%29.pdf. Accessed on 18 September 2025.
Ministry of Health and Family Welfare (MoHFW). National Guidelines for Village Health, Sanitation and Nutrition Day (VHNSD). New Delhi: Government of India. 2019. Available at: https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/CH/Guidelines/National_Guidelines_on_VHSND_English_High_Res_Print_ready.pdf. Accessed on 18 September 2025.
NITI Aayog. Nutrition strategy: A strategy for India’s nutrition. New Delhi: Government of India. 2017. Available at: https://library.niti.gov.in/cgi-bin/koha/ opac-retrieve-file.pl?id=a0185815c4868 f92466245d 161108c36. Accessed on 18 September 2025.
Avula R, Menon P, Saha KK, Bhuiyan MI, Chowdhury AS, Siraj S, et al. A program impact pathway analysis identifies critical steps in the implementation and utilisation of nutrition interventions in Odisha, India. Matern Child Nutr. 2015;11(4):915-31.
Kohli N, Avula R, van den Bold M, Becker E, Nisbett N, Haddad L, Menon P. What will it take to accelerate improvements in nutrition outcomes in Odisha? Learning from the past to prioritize the future. Glob Food Sec. 2020;12:38-48. DOI: https://doi.org/10.1016/j.gfs.2017.01.007
Ministry of Women and Child Development (MWCD). Operational guidelines: Saksham Anganwadi & POSHAN 2.0. New Delhi: Government of India. 2022. Available at: https://wcd.delhi.gov.in/sites/default/files/WCD/generic_multiple_files/final_saksham_anganwadi_and_mission.pdf. Accessed on 18 September 2025.
Johri M, Rodgers L, Chandra D, Abou-Rizk C, Nash E, Mathur AK. Implementation fidelity of village health and nutrition days in Hardoi District, Uttar Pradesh, India: a cross-sectional survey. BMC Health Serv Res. 2019;19(1):756. DOI: https://doi.org/10.1186/s12913-019-4625-9
Saxena V, Kumar P, Kumari R, Nath B, Pal R. Availability of Village Health and Nutrition Day services in Uttarakhand, India. J Family Med Prim Care. 2015;4(2):251-6. DOI: https://doi.org/10.4103/2249-4863.154667
Pérez-Escamilla R, Engmann C. Integrating nutrition services into health care systems platforms: Where are we and where do we go from here. Matern Child Nutr. 2019;15:e12743. DOI: https://doi.org/10.1111/mcn.12743
Pati S, Mahapatra S, Sinha R, Pati S, Samal SN. Community management of acute malnutrition (CMAM) in Odisha, India: a multi-stakeholder perspective. Front Public Health. 2018;6:158. DOI: https://doi.org/10.3389/fpubh.2018.00158
Jha SS, Dasgupta A, Paul B, Ghosh P, Yadav A. Evaluation of village health and nutrition day program in a block of Hooghly District, West Bengal: a mixed-methods approach. Indian J Public Health. 2021;65(2):130-5. DOI: https://doi.org/10.4103/ijph.IJPH_621_20
Pati S, Chauhan A, Palo S, Sahu P, Pati S. Assessment of Village Health and Nutrition Day implementation – findings from a mixed method study in Odisha, India. Clin Health Promot. 2016;6:42-8. DOI: https://doi.org/10.29102/clinhp.16007
Tulenko K, Møgedal S, Afzal MM, Frymus D, Oshin A, Pate M, Quain E, Pinel A, Wynd S, Zodpey S. Community health workers for universal health-care coverage: from fragmentation to synergy. Bull World Health Organ. 2013;91(11):847-52. DOI: https://doi.org/10.2471/BLT.13.118745
Gopalakrishnan L, Patil S, Fernald L, Walker D, Diamond-Smith N. Association between coordinated counseling from both ASHA and Anganwadi workers and maternal health outcomes: a cross-sectional study from Madhya Pradesh and Bihar, India. PLOS Glob Public Health. 2024;4(11):e0003639. DOI: https://doi.org/10.1371/journal.pgph.0003639
Ministry of Health & Family Welfare (MoHFW), National Health Mission. Home Based Newborn Care – Operational Guidelines (Revised 2014). New Delhi: NHM/MoHFW. 2014. Available at: https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/Revised_Home_Based_New_Born_Care_Operational_Guidelines_2014.pdf. Accessed on 18 September 2025.
Scott K, George A, Ved R. Taking stock of 10 years of published research on the ASHA programme: examining India’s national community health worker programme from a health systems perspective. Health Res Policy Syst. 2019;17(29). DOI: https://doi.org/10.1186/s12961-019-0427-0
Khan DSA, Das JK, Zareen S, Lassi ZS, Salman A, Raashid M, Dero AA, Khanzada A, Bhutta ZA. Nutritional status and dietary intake of school-age children and early adolescents: Systematic review in a developing country and lessons for the global perspective. Front Nutr. 2022;8:739447. DOI: https://doi.org/10.3389/fnut.2021.739447
Kamble RU, Garg BS, Raut AV, Bharambe MS. Assessment of functioning of Village Health Nutrition and Sanitation Committees in a district in Maharashtra. Indian J Community Med. 2018;43(3):148-52. DOI: https://doi.org/10.4103/ijcm.IJCM_171_17
Ved R, Sheikh K, George AS, Raman VR. Village Health Sanitation and Nutrition Committees: reflections on strengthening community health governance at scale in India. BMJ Glob Health. 2018;3:e000681. DOI: https://doi.org/10.1136/bmjgh-2017-000681
Karuga RN, Mireku M, Muturi N, McCollum R, Vallieres F, Kumar M, et al. Supportive supervision of close-to-community providers of health care: Findings from action research conducted in two counties in Kenya. PLoS One. 2019;14(5):e0216444. DOI: https://doi.org/10.1371/journal.pone.0216444
Downloads
Published
How to Cite
Issue
Section
