in India

Who are the Anganwadi workers?

These ladies are supposed to be married into the village- that means she is going to stay there; that is one of the selection criteria, and this lady then provides both primary healthcare, ante natal checkup, but her main focus is getting all the children of the village who are less than a certain age, and giving them nutritious food and, during play, teaching them certain things. Angan means a courtyard- that kind of thing- a small room with a little opening in front of it where the kids can play, and people can sit…

How do they find out if somebody has Tuberculosis and what do they do? And how do they assist in the treatment of Tuberculosis patients?

They are normally the DOT providers, so they are the ones who do the patient introduction counseling and delivery of drugs to the patient as per DOTS strategy. In case there is a person who has been having a cough for three weeks or more she will ask them to go to a regular DOTS microscopic centre, where the person will be investigated and then if diagnosed to have TB they will be categorized, and then once the health system develops a network with this Anganwadi worker, the Patientwise Box (which we have in the programme, and contains the entire treatment for one patient in that box so that there is never a stock out position for that person), is then transported to the Angan (the small room from where she works), and this box stays there, from where she gives the DOTS treatment to the patients on a regular basis.

And what is a Patientwise Box?

A Patientwise Box is an innovation of our programme and I think it is well-recognized globally. Because we follow three categories of treatment, categories 1 to 3, we have three generic boxes: category 1 box will have 2 pouches in it, and each pouch will have the intensive phase and the continuation phase drugs all packed in blister packs in that box. When a patient is registered, the name of the person, the TB number, age, sex, it is all written on the box, and all the medicines to be given to the patient for their TB management will be coming out of the box, so there is never a stock out position for that patient.

What does the Anganwadi do when the patient does not take their medicine?

When the patients default it is very easy for the Anganwadi worker to retrieve them, because she is from the village, she knows every house, every person who lives there, and people respect her because of the care she provides to the community, so she has very easy access to getting the patients back. They are in my opinion very good counselors, they have over the years learned the art of counseling and have done that very well, and so they can bring them back easily. Sometimes there are people who are a little difficult, especially male patients who could be alcoholic and don’t listen to anybody. Then she uses the influence of the village elders to put some good sense into that patient and bring them back.

How many people in India do the Anganwadi reach?

The Anganwadi network is across the country, in different states they are known by different names. In one of the states where the Global Fund (grant) is working called Jharkhand, they are called Mithanins, and these are a little bit more than Angan Wadi workers, they also help in childbirth.

Where are the Anganwadi workers found?

The Anganwadi workers are at the village level, so there are villages which are maybe 100 km from Delhi, but there are places which are very far off, for example one of the villages where the Global Fund is supporting called Uttaranchal, which is very far-flung… it is far away from Delhi, you have to first take a train to the capital city of that state then take a bus then take local transport, then walk for a few hours or maybe days before you get to the village, and there is a lady there who is doing all this !

Do the Anganwadi workers get paid?

She is a voluntary worker, she gets her remuneration which is very nominal but she is not a salaried person, but she gets her honorarium on a monthly basis. Whenever they complete the treatment of one person (TB patient), they are entitled to a very nominal fee of 250 Rupees, which would be a few dollars.

Are the Anganwadi the only people who reach TB patients?

The other new innovation which the Government of India is working on is a lady called ASHA (Accredited Social Health Activists), and these ladies would be more focused on health itself. In many villages they have already started recruiting them and they have started being trained and working, and they are also based in the villages.

In a situation where there is no Anganwadi worker, Mithanin or ASHA who provides this service?

In most of the places there would be an Anganwadi worker, but sometimes some males, especially male TB patients may have a little hesitation going to a female worker or somebody, so in such cases we have used Dakiyas, who are the postmen of the village, but also the male school teacher, he is also well respected. Dakiyas are also very well respected and in many places have become very good drug providers.