Poshan Tracker

Malnutrition is a complex issue that requires international attention, and several strategies have been employed globally to address it:

1. Food Fortification : This involves enhancing the nutritional value of food by adding micronutrients. An example would be the fortification of salt with iodine, often used to prevent iodine deficiency disorders. 
2. Nutrition Education: Increasing awareness and knowledge about balanced diets and the importance of nutrition can lead to better food choices and dietary habits. This is often implemented in schools or community centers.
3. Supplementary Feeding Programs: These are interventions where nutrient-rich food supplements are provided to vulnerable groups, such as children and pregnant women. 
4. Agricultural Interventions: These strategies promote the production and consumption of nutritious food, for instance, biofortification (growing crops with higher nutrient levels) or supporting small-holder farmers to improve productivity and crop diversity. 
5. Social Protection Programs: These are aimed towards supporting low-income households to access nutritious food. For instance, providing conditional cash transfers or food vouchers. 
6. Healthcare Interventions: These include providing micronutrient supplements, deworming and immunization programs, and regular health check-ups to identify and address early signs of nutritional deficiencies. 

While these practices are effective to some extent, integrating them with digital technologies in form of a Digi-Nutrition application can streamline the process and make it more efficient. Such an application could offer personalized dietary recommendations, track nutrient intake, deliver nutrition education virtually, and connect users to local resources and health care services.

Reports of National Health & Family Survey, United Nations International Children’s Emergency Fund, and WHO have highlighted that rates of malnutrition among adolescent girls, pregnant and lactating women, and children are alarmingly high in India. According to a survey done by UNICEF using National Family Health Surveys of 2019-21 and 2005-2015, the proportion of stunted and underweight children has declined over the years, however it is still too high for us to be complacent. Though the incidence of overweight children has multiplied with wasting remaining constant. Similarly, the current problem of malnutrition amongst women is not promising either.

In the context of India, the problem of malnutrition is pervasive particularly amongst children below the age of 6, adolescent girls, pregnant women and lactating mothers for whom it is of utmost importance to have access to a balanced diet. Reports of National Health & Family Survey, United Nations International Children’s Emergency Fund, and WHO have highlighted that rates of malnutrition among adolescent girls, pregnant and lactating women, and children are alarmingly high in India. According to a survey done by UNICEF using National Family Health Surveys of 2019-21 and 2005-2015, the proportion of stunted and underweight children has declined over the years, however it is still too high for us to be complacent. Though the incidence of overweight children has multiplied with wasting remaining constant. Similarly, the current problem of malnutrition amongst women is not promising either. Women do not fare well when it comes to diabetes and being underweight. The incidence of overweight children has increased phenomenally to a proportion of 42%. 

Evidently, India needs to work more actively and diligently to eradicate the loopholes in the implementation of the various schemes in order to ensure that everyone gets a healthy diet to have a better and healthy future. 

Malnutrition can have extremely dangerous effects on the economy of our country, significantly affecting the GDP. According to a World Bank report, India suffered an economic loss of Rs. 24,000 crore due to lack of toilets leading to a health impact of 38 million dollars on the Indian economy. The Assocham study of 2018 states that the GDP plummeted with a decline of 4% due to malnutrition. A report claimed that children who suffered from malnutrition after growing up earn 20% less than those with healthy childhoods. The number of SAM children has reduced to 10 lakhs which deserves appreciation.

The Government of India has initiated various programmes to address the problem of malnutrition, including schemes like Integrated Child Development Scheme (ICDS), Pradhan Mantri Matru Vandana Yojana, Anaemia-mukt Bharat, health schemes like Mission Indradhanush, Intensified Home-based Newborn Care, livelihood promotion through MGNREGA, sanitation and hygiene through Swachh Bharat Abhiyaan, etc.

It was not until the mid-seventies that proper surveying techniques were put to use and data on nutrition was collected. Integrated Child Development Services (ICDS) Scheme was launched in 1975 to improve the nutritional and health status of children below the age of 6 years and mothers (pregnant and lactating) by provision of Take Home Ration (THR), Hot Cooked Meals (HCM) and other benefits4. According to data from the World Bank, UNICEF and WHO5, in 1989, the percentage of children with a stunted growth was 62.7% while 55.5% children were underweight. Since then, several policy measures have led India to do better on these metrics. In 2017, stunting and underweight children dropped to 34.7% and 33.4% respectively, but still fell short of other countries. India’s population is on an increasing trend and closing in on China’s population. But if we compare the current health expenditure (CHE)6 as a percentage of GDP, India continuously falls short- with average CHE of 4% as compared to 5% for China. Additionally on comparing data for USA, we observe a reverse trend of a low population, but a higher average CHE of 16% (refer Fig. 1).

A reduced health expenditure coupled with a growing population, requires highly efficient use of current resources to extract maximum value of the existing infrastructure. In a bid to create a healthier Bharat, India pledged to SDG 2 which aims at reducing and maintaining wasting by 5%, stunting by 40% and no further increase in childhood obesity by 20307. However, reaching this goal may not be as straightforward as it seems and requires a major rehaul in the way nutrition is perceived and tracked.

Technological solution of tracking diet that works in diverse regions for diverse people and diverse nutritional requirements uniformly. Designing a technological solution for tracking diet that works across diverse regions, for diverse people with various nutritional requirements, requires careful planning, consideration of cultural differences, and flexibility.

Designing a technology solution for tracking nutrition in diverse regions and among diverse people is a complex task that requires a deep understanding of cultural, nutritional, and technological factors. It’s essential to approach this task with empathy, inclusivity, and a commitment to continuous improvement.

Historical Background

Anganwadi Workers (AWWs) and Anganwadi Centres (AWCs) are the main channel used by the government to reach out to pregnant women and mothers of children under the age of 6 in remote locations. AWWs are government appointed workers who perform several functions related to health and nutrition of women and children. The complete list of functions for an AWW is listed in Exhibit 1. As of 2022, there are over 1.4 million registered AWWs who operate on ground and play a pivotal role in distribution and management of nutritional food and information. The AWWs are mapped to a Supervisor, who further reports to Child Development Project Officer (CPDO). CDPOs are mapped to District Programme Officers (DPOs) who then report to the Ministry of Women and Child Development8. Majority of the duties of an AWW revolve around tracking and keeping a note of key health metrics for women and children.

Up till 2017, this data was captured by the AWWs in physical paper-registers, an exhaustive list is depicted in Exhibit 2. This made the process of recording data slow, inconvenient and also prone to damage by wear and tear. While the mandated granularity of reporting for collected data is showcased in Fig. 29, it is observed that, the information moved at a relatively slow pace with a delay of almost 15 days in recording and reporting starting from AWWs to Ministry of Women and Child Development. This slack in reporting had a cascading effect on implementation of newer initiatives and tweaks in existing schemes, leading to delayed benefits for final beneficiaries. 

A quick, robust and reliable system was needed to be built in order to overcome the above stated hardships and help the government accomplish its nutritional goals. With mandate of removing these hurdles, The Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan was launched in 2018 to improve nutritional outcomes for children, pregnant women, lactating mothers and adolescent girls, with four key pillars as per Fig. 310.

As in June 2022, the Jan Andolan dashboard shows the progress of various flagship events across the nation and highlights their performance11. Under the umbrella of POSHAN Abhiyaan, POSHAN tracker application was launched as a tool for e-governance and to enable a better tracking of the on-ground metrics more frequently. It was aimed to give 360 degree visibility into working of AWWs and AWCs while digitizing the journey of AWWs to enable better disposal of services and making data entries less tedious and more efficient. The purpose of the application was not to digitise medical practice, but to provide recommendation based on early signs of a medical distress by tracking key health metrics. 

POSHAN Tracker Developmental Process

POSHAN Tracker has been developed in the form of an android application by the Ministry of Electronics and Information Technology12 for reducing the administrative load of AWWs and AWCs and to help them dispense their duties in a better way, while giving dynamic, on ground situation updates to relevant authorities in real time. 

The application underwent several iterations before its launch on the android play store. The data that is dynamically collected was initially hosted on NIC cloud and then moved to a third party platform- Amazon Web Services (AWS) for better monitoring and performance. AWS’s Redshift technology is being leveraged to effectively handle the enormous amount of data that is generated daily. The app is dynamically updated as per the feedback given by nodal officers based on complaints received by the on ground users. As on 20th July 2022, there have been more than 50 updates in the application to improve its look, feel and features. Technology like message queue and caching mechanism has been introduced for better performance and to manage the scalability of the program.

The application has several features that may be used and leveraged by multiple stakeholders differently. The major stakeholders include beneficiaries, AWWs and AWCs, ICDS Supervisors and Officials, relevant ministries of Government of India and society at large.

2.1 For Beneficiaries: The app triggers automated SMS alerts to parents of children who were noted to have stunted growth or were found to be suffering from malnutrition. The alerts also motivate parents to take better care of their children and make further use of ICDS services.

2.2 For AWWs and AWCs: The app has 4 key modules and several other sub-modules for AWWs that replace 10 out of 11 paper-based registers earlier maintained by them. The 4 modules on home page include Beneficiaries; Home Visit Scheduler; Verify Aadhaar and Daily tracking.

Beneficiaries: There are 7 types of beneficiary categories namely Pregnant women; Lactating mothers; Children (0-6 months); Children (6 months-3 years); Children (3-6 years); Adolescent girls and Orphan children (Orphan children were only included during the time of Covid-19 Pandemic to extend support to those who lost their parents)

The app allows the AWWs to enter the data for a new beneficiary in the relevant category and allows to populate an auto-generated form based on the beneficiary type selected and capture the relevant data. For instance, when registering a pregnant woman, the displayed form would ask for key metrics like hemoglobin level, age, height, and weight of the mother. The form also gives the AWW an option to migrate a pregnant woman to a lactating mother category later, allowing for a quick and easy migration of a beneficiary from 1 category to the other based on their lifecycle stage. The app has various options for various beneficiaries listed below:

• Pregnant Women
  • Update profile details 
  • Migrate to lactating mother 
  • Add growth and nutritional details 
  • Add vaccination details 
  • Delete beneficiary
• Lactating mothers
  • Update profile details 
  • Add growth and nutritional details 
  • Delete beneficiary 
• Adolescent girls 
  • Update profile details 
  • Add growth and nutritional details 
  • Growth monitoring
  • Add vaccination details 
  • Delete beneficiary
• Children (0-6 months)
  • Update profile details 
  • Add growth and nutritional details 
  • Growth monitoring
  • Add vaccination details 
  • Delete beneficiary
• Children (6 months – 3 years)
  • Update profile details 
  • Add growth and nutritional details 
  • Growth monitoring
  • Add vaccination details 
  • Delete beneficiary
• Children (3 years- 6 years)
  • Update profile details 
  • Add growth and nutritional details 
  • Growth monitoring
  • Add vaccination details 
  • Delete beneficiary
• Orphan children
  • Update 
  • View DCPO’s Comment13

Home Visit Scheduler: Data from the “Beneficiaries” module helps in auto-prioritization of the AWW’s visits to various households. The prioritization is undertaken based on identification of crucial stages in the lifecycle of a mother and a child. This allows the AWWs to better manage their visits and ensure that no beneficiary who is in dire need of support gets left out from the benefits. There are 3 screens in the application- one that shows the visits that are due on the given day, second screen shows the upcoming visits and third shows the visits that are late. 

The app allows for services like THR and HCM, vaccination for infants and pregnant women to be tracked on a daily level. Children of different age groups are monitored on monthly basis by AWWs. Health indicators like Stunting, Wasting and Underweight prevalence are measured as per WHO standards. Regular growth monitoring help AWWs to provide relevant and timely assistance to children.

The app also contains 3 separate modules for the AWCs. These modules enable the AWCs to keep daily track of activities as per Exhibit 4. These features allow the AWCs to monitor and track their performance and also raise concerns in case of an infrastructural need. 

2.3 For ICDS Supervisors: ICDS Supervisors provide mentorship and supervision to 20-25 AWWs. The app allows the ICDS Supervisors to get more visibility into the performance and day-to-day functioning of AWWs and AWCs by regular tracking of their movements. By tracking metrics like number of visits made by an AWW, HCMs served and THRs distributed, an ICDS supervisor can determine the efficacy of the AWWs mapped to him/her. 

The app also allows for easier conduction of audits by giving a checklist for conducting visits. A dynamic dashboard has been created to enable more data driven decision making. 

2.4 For ICDS Officials: With a combination of mobile app and web based dashboards, Nodal officers and other ICDS officials get real time information of the performance of AWWs and AWCs on field. This allows for better decision making and performance tracking. POSHAN Tracker allows for various reports to be generated on a daily/ monthly basis (Exhibit 3) which may further be used for better roll out of schemes and benefits. However, the stakeholders involved are not limited to these 4 identified groups. Everybody in the nation is a stakeholder as proper health and nutrition is needed for the nation to make progress. 

2.5 Ministries of GoI: The information provided by the app is of great use and relevance to the Ministry of Women and Child Development14 as it directly impacts their programs for nutrition and well-being of mother and child. Dynamic data helps them take more data driven policy decisions and also helps them ensure that the benefits of the already implemented schemes are reaching the final intended beneficiaries properly.

2.6 Society: The society as a whole is the biggest stakeholder. The application facilitates the proper distribution of precious government allocated resources and also contributes to majorly improving the current functions of AWWs. The data from the app is a direct representation of the on-ground reality of health and wellbeing of the citizens. Geo tagging of the data allows for us to know which parts of the society are facing the problem more acutely and require greater attention. 

Challenges faced by Angadwadi Workers

Quality of phone

The phones provided to the workers are of low quality. These phones are unable to handle the load of application thus, result into sudden hanging, shut down, memory issues etc. This is very first step to be taken care in order to digitalize data as it is soul of the project. Some respondents are not using the phones. They have downloaded the application in their personal mobile and others go to cyber café to update the data. Few have kept the phones a home and children play with them. If Anganwadi Staff is opting all the options other than using government phones, then what is the point of all these efforts? Also, If the phones provided are not working properly, how can we proceed to further steps and achieve the goals? The solution to this issue is to replace the phones with around 4 GB RAM and Memory of 64 GB or more.

Improvements needed in the application

When the workers update data, they face some technical issues. Sometimes the application is down so result in delay in update of data. Also, they have to open each and every profile for updating data other than attendance, which is tedious and time consuming. Also, they have to take few attempts to update daily basic details like HCM (Hot cooked meal), THR (Take home ration), height details etc. This turns into disappointment for them as they are unable to update in one go. This is very important point to be worked upon. The Anganwadi staffs is losing interest day by day and are more attracted to traditional register work which is opposite to the goal behind launching the application. The solution to this issue is simplifying the application so that the daily task of updating data is done in one attempt hence, not a tedious and disappointing site. The need for opening each and every profile of children should be dropped and can be accessed with one click just like the attendance option does.

Adequate Monthly incentive paid to staff

According to the respondents, the amount paid to them is not adequate. The Anganwadi worker (AWW) and Anganwadi helper (AWH) gets rupees 500 and 250 per month respectively. The amount paid doesn’t justify their efforts. They have to open each and every profile other than attendance so takes a definite time for this daily and have to do it daily. Along with this, they have to maintain registers too. If they have to maintain registers then why need of application is there and if application is there then, why they have to maintain registers. This dilemma discourages them to use application along with inadequate amount received. The possible solution is to increase the level of monthly allowance and reduction in no. of registers maintained.

Delayed payment and Fine

According to respondents, they were promised a fixed amount for internet recharge. They told that in the starting few months, they received it. Nowadays, either they are receiving it late or not receiving at all. They have to pay for recharge from their own pocket. They already have low salary and this issue puts fuel in fire. The phones provided to them in case lost, then have to pay fine of rupees 10,000 which is too high. They would prefer to buy phone from store and enjoy it of better quality for work. The possible solution is strict action on delay and ensuring the timely payment to them. For the fine, the amount should be brought down as they are already irritated with the quality of phones.

Location of Anganwadi Centers (AWCs)

The anganwadi centers are usually located within house. A hall or a room is rented and turned as local center which is of 20-30 meter square. The reason behind this small space is that the property itself is of 50-60 m square. So, they are not able to find center as per the space guidelined to them. Also, it is hard to find a big space as the landlords earn can earn 4 times more by renting same space for commercial purpose. At last, the only option left is to run center in rooms of houses. The only solution to this problem is to raise the rent allowance so that they can shift to a better place. This amount will help them to shift in a well furnished and spacious on road property not built inside a house.

Cost Benefit Analysis

The Abhiyaan empowers Anganwadi workers and Lady Supervisors by providing them with smart phones, and as of now the no. of smart phones and Growth Monitoring Devices (comprises of Stadiometer, Infantometer, Weighing Scale for Infant and Mother & Child) procured by States/UTs are 1.103 million and 1.194 million respectively15. The state wise budget allocation and their status is attached in Exhibit 5. 

The current status of state-wise beneficiaries of POSHAN Abhiyaan have been attached exhibited below:

The cost of recording and maintaining the data of the beneficiaries on the app comes out to be 1 INR per beneficiary per annum16. This is one of the most economical projects that captures all health related metrics in a succinct and WHO acceptable standards at such a minute cost. 

For financial year 2021-22, allocations for Saksham Anganwadi and POSHAN 2.0 stood at Rs. 2,01,050 million. This is lower than financial year 2020-21 Budget Estimates (BEs) for the erstwhile ICDS which stood at Rs. 2,05,320 million17. 

Impact

Initially, there was some resistance by the AWWs towards adoption of technology. This was eventually overcome by extensive training sessions and provision of helpline numbers and an in-app issue form for any additional concerns. As on June 10, 2022, there are a total of 14,03,656 AWWs registered on the app. The total app downloads stand at 12,65,328 and more than 110 million beneficiaries have been reached via the platform. The number of transactions on the app have increased from 30 million daily in December 2021 to 170 million per day as on 20th July 2022. After the launch of the app, the distribution of ration and other services rendered by AWWs have been streamlined as data is captured daily. 

This daily data capturing has allowed for a more data driven decision making. Nodal level officers now have a visibility into the on-ground situation dynamically which allows for swifter decision making. The “comment” section in the app also allows for the nodal officers and other high-ranking officers to send in comments and feedback directly to AWW/AWCs without having to take the traditional paper route which was longer and time consuming. 

In terms of ease of governance and efficiency of the existing machinery, it was noticed that within the first few months of the launch of the application, the visits by the AWWs were regularized more and the uptake of THR and other services also saw an increase. 

Data Analysis

Research Methodology:

Frequency distribution is a fundamental technique in research methodology used to organize and summarize data collected during research studies. It involves the tabulation of data into a structured format that shows the number of times each value or category occurs in a dataset. This technique is commonly used in various fields such as statistics, social sciences, economics, and natural sciences to gain insights, identify patterns, and describe the distribution of data.

Here are the key steps involved in creating a frequency distribution:

• Collect Data: The first step is to collect the raw data relevant to your research question or hypothesis. This data could be in the form of numerical values, categories, or any other discrete observations.
• Sort Data: Arrange the data in either ascending or descending order. Sorting the data helps identify patterns more easily and makes it ready for tabulation.
• Identify Range and Intervals: Determine the range of values in your dataset and decide on the size of intervals (bins or classes) into which the data will be grouped. The choice of interval size depends on the nature of the data and your research objectives.
• Create Frequency Table: Create a table with columns for the intervals or categories and a corresponding column for the frequency (the number of data points that fall into each interval). Tally or count the number of data points within each interval.
• Calculate Relative Frequencies: In addition to the frequency, it can be useful to calculate relative frequencies (percentages) by dividing the frequency for each interval by the total number of data points. This helps in comparing different datasets or making the distribution more interpretable.
• Construct Graphical Representations: Visual representations such as histograms, bar charts, or frequency polygons are often created to present the frequency distribution graphically. These visuals make it easier to understand the distribution’s shape and characteristics.
• Analyze and Interpret: Once you have constructed the frequency distribution table and graphical representations, analyze the data to draw conclusions and make inferences. You can identify central tendencies (mean, median, mode), measures of dispersion (variance, standard deviation), and assess the skewness and kurtosis of the distribution.

Frequency distributions are essential in research for several reasons:

1. Summarization: They provide a concise summary of data, making it easier to understand and interpret large datasets.
2. Pattern Identification: They help researchers identify patterns, trends, and outliers within the data.
3. Comparison: Frequency distributions allow for easy comparisons between different datasets or subgroups within a dataset.
4. Hypothesis Testing: They serve as a basis for hypothesis testing and statistical analysis.
5. Data Visualization: Graphical representations of frequency distributions help convey information effectively to a wider audience.

In summary, frequency distribution is a crucial technique in research methodology for organizing, summarizing, and presenting data, facilitating data analysis, and drawing meaningful conclusions from research findings.

Research Design

This study seeks to find out experience of using Poshan application. All the questions were framed in such a way that they describe how effectively the application captures and maintains track of the data it intends to collect. Along with-it, open-ended questions were discussed by face-to-face interaction. For collection of data, a questionnaire was made which included 11 questions and made compulsory to answer. The link was shared to AWH and AWW during field work. They answered question as per their experience with the application.

Universe of study

The research study involves the analysis of sample of two groups. First group consisting end users and second group consisting implementing agency, selected through random sampling.

Locale of the study

The locale of the study is Delhi and nearby cities. Various AWC were visited to gather the data e.g Vasant Kunj, Kusumpur Pahadi, Saket, Gurgaon, Faridabad, Rohini and Bahadurgarh

Sample Size

The sampling was convenience based upon users i.e. AWW and AWH , 486 responses were gathered out of which 444 were adequate. 

Data Analysis

The collected data was then analysed through descriptive statistics to identify, organise and visualise the most reliable information to inform the findings and recommendations..

This part discusses the findings and implications of the Poshan Application. 

To provide a comprehensive picture of the survey data, descriptive statistics using SPSS were generated. Measures including mean, median, standard deviation, and range were computed for pertinent variables in the quantitative survey data.

To understand AWW experiences with Poshan Application, qualitative data was gathered. The results received from the survey were evaluated through a thematic analysis. Positive, neutral, and negative opinions were noted, and common themes pertaining to user experiences were derived. 

From analysis of data, we got to know that there are mixed responses on application. Around 48 % AWW and AWH are highly happy with the application by choosing option “exceeded their expectations’. More than 40% population strongly agreed that they are comfortable with the application. This is revealed by the response to question no 10. There are many reasons behind this. According to them, they do not have to take out various manuals to enter data. There are fewer stacks of manuals in a corner as most of data is updated on the application. They show their positive attitude towards digitalization. So through this, it can be concluded that they are comfortable and support the digitalization aspect. They do want to end the existing manual and tedious work and therefore are fully engaged in app.

Point to be noted here is that these responses are coming from staff of age mostly ranging 25-35 years old. As they were already familiar with working of mobile phones so they easily got comfortable with app after the training session. This way, it can be concluded that the newer generation is comfortable with the up gradation. They just need trainings to be able to work smoothly.

The second type of AWH and AWW are neutral towards the application. It can be known from the responses. Around 32% respondents ticked that it just met their expectations. They are indifferent to the changes happening. According to them, they have to update data whether it is manual or application. Once it is done, they take care of other daily task of AWC. They told that, in the beginning issues were there within the Poshan application so, working with it was little disappointing. As they were provided training time to time, they slowly got used to it. At that time there were some issues in app which was not letting them work smoothly, but got resolved because of regular updates. It showed that the training has helped them to be able to cope up with changes

The group that is neutral towards the application was mainly the ones which do not have large amounts of data updation. Many of them are also highly skilled in their field. They are very clear where and how to update data. When they shifted to application, working on it was unfamiliar. The training program filled resolved the unfamiliarity issue. Now heading towards third group which say the applications didn’t meet their expectations. According to them, the application was not an easy thing to use. The site went down while updating various details. According to them paper work is much better than the online work. Many of them even suggested that the application may be discontinued as they had to maintain manuals too. This doubled their workload.

It is important to note that the AWW are not resisting the changes, they just want few more things to add up. First, time to time updates in the applications as there are still issues faced by them while working on it. Second, either digitalize the existing paper work i.e. to maintain manuals or remove the application work as it creates double burden. Third, is to raise the level of monthly incentive to around 2000 as working with application takes time.

Results and Findings

The finding is related to inferences made concerning the primary research question, detailed analysis of Poshan Application, for which the survey was conducted. For the collection of primary data, interviews, questionnaire fill up and survey were conducted. The questionnaire made for end users was shared and data was collected from 444 respondents and analyzed. The AWW and AWH were familiar with the application as they use it every day. Some have installed it in government phones and some did in personal phone. The reason behind installing in personal phones as told by them was that phones are of low quality. The storage and RAM capacity needs to be updated. 

The analysis of the primary data is discussed as follows-

Responses on access and navigation to the tracker

Sources: Author’s Working

A good access and navigation is experienced while using the application. One can easily log in and log out it. Once logged in, one can easily do navigation. It was strongly agreed by the 21% users and 23% simply agreed. Summing it up makes 43% which is pretty good as it is nearly half. Further, only 3% strongly disagreed which is just a small proportion. Interpretation can be made in this way. The simplified registration process makes it easier to manual themselves once registered, one can easily put id and password to open it. The attendance part works smooth thus, updated within minutes. This also provides answer to the question asked on responsiveness. At present, the tracker is responsive most of time So, user experience is mostly positive. The negative responses are due to issues like tricky to upload data like height, HCM, site being busy etc. Because of this, the application got negative reviews. It needs to be more users friendly. If these issues are resolved, the experience will become positive overall.

Tracker application provides a sense of security, processing of information and validation of facts in a secured manner

Sources: Author’s Working

They are comfortable in sharing details of children and pregnant ladies. The Aadhar card is required to manual every child and parents seem comfortable in sharing details because the tracker relates to the ministry. They do not find risky in sharing other details when asked. So, there is sense of security among workers as well as beneficiaries for the application. Coming to processing of information aspect. This factor got negative reviews. The workers said that there are technical issues while validating information.

Application reflects competency of the staff involved in design and delivery of services 

The site suddenly goes busy, backs off etc. they must sometimes upload information again and again. It reflects that the AWW are not able to express their competency. The staff aging 25 – 45 years which makes around 58 % is good enough to work on it. The people falling in 45+ are not able to reflect their competency. According to them, the tracker need to more user friendly. As they occupy a significant share, their opinion needs to be considered.

The service reflects a 360 degree view of the activities of the Anganwaadi Center (AWC)

Yes the application is able to reflect it. It can be known through the responses. Around 55% respondents either agreed or strongly agreed for it. It is due to fact that most of the daily activities can be updated it just by click. There are just few tasks which still need to be maintained in manuals. For this reason 21% respondents went for strongly disagreed or disagreed.

Application seem comfortable to update health related details

Yes, detail scan be updated easily on the tracker with positive feedback of 61%. The attendance can be done in one go as the list appears. They just have to tick the names. Other than that, for HCM, height details, growth measurement, THR, pregnant ladies data, they have to visit every profile. With the help of growth monitoring features, SAM ( Severly Acute children can be easily identified. The workers below age of 45 are comfortable with the application. They are familiar with the digital work thus skilled enough to work on it. Along with this the training program helped them to handle things better. The negative responses have share of 19%. The possible reasons are due to the fact that the older generation is used to traditional work, hence they face issues.

Application is responsive enough to your needs in terms of your requirements for daily tracking, home visits and growth monitoring

With the 88% votes in favor, the analysis shows positive results. Tracker helps in effective management of preschool education activities especially of backward areas. Activities related to social, physical, creativity, emotional etc. are being experienced by children. From the monitoring feature, SAM (Severely Acute Malnutrition) and MAM (Moderate Acute Malnutrition) children can be easily identified, provide details about vaccination of infants and pregnant women. The tracker generates home visit alerts, notifying about schedule. It helps in consistent follow up and assessments, enabling efficient monitoring, nutrition and health counseling etc.

Easy access to /log-in and navigation protocol to the Poshan Tracker Application

Yes, the login and navigation is easy. Once, a profile is manualed,one do not need to log in and log out again and again. Most of the respondents keep their account logged in all the time. Due to the trainings provided time to time, they smoothly navigate into the site. In the start they had to memorize the option. Some workers used to note down in copies. As the time passed and they had enough practice of tracker, they got comfortable. Now, they have knowledge of various options available in the tracker. They are familiar how the app works. Sometime when application is down, they wait for an hour and work again. Overall for the younger generation, it is easy. The negative reviews summing up to 20% mostly were from older workers. The possible reasons are already discussed.

Communicate adequate information in a clear manner

Yes, from the majority of respondents with 64%. There are two reasons for it. First is being updated with the world of technology. So, they are comfortable with working of phone as well as the application. Even if there are doubts, they are resolved by the trainings. In turn they become expert at tracker. They can understand which option asks for which information. It time to time informs them for home visits which is cherry on cake. The trainings as discussed brings clarity. Just 15% were not in favor. As the share is quite low, the negative reviews should not be given weightage.

Poshan tracker application gives assurance in terms of information and services it delivers

Around 61% population agreed to this. The reason behind it is a sense of security, regular updates, trainings provided, easy login etc. So, this way, respondents were assured about the application. While working on tracker they were informed whether data has been updated or not, thus no space for doubts. For the negative response, there were around 19% respondents who either disagreed or strongly disagree.

Seem comfortable for user

Around 64% respondents agreed to it. The language option helps them to understand things better. So, if someone is not comfortable with English, they can go to More section->Select language and confirm. It is due to the trainings provided to them. These sessions have helped them to cope up the changes. As they have knowledge how and where to upload data, they can easily work with it.

Understand your need and requirement

22% respondents strongly agreed to this. It is enough to show that there is positive attitude towards it. As most of data is updated there, so it understands need and requirements of the users. It offers various choices under various heads thus promote clarity while working. Infact, from time to time updates are there, thus points towards the prediction factor.

Finally the last question was on the overall efficacy of the Poshan Application. The responses indicate an overall positive outlook towards the use of the application by the Anganwadi users.

V. Way forward

The success of POSHAN tracker has proven that it is an efficient and effective tool for e-governance. The application’s quick adoptability by mildly tech-literate AWWs is a proof that technology, when leveraged properly may create massive waves in terms of impact. The roadblocks and challenges faced by the Ministry of Women and Child Development are not unique to their predicament with AWWs and AWCs. Similar technological infrastructure may be leveraged by other ministries as well to collectively work towards making new India by leveraging technology.

Adoption of change by AWW and AWCs

Encouraging less educated workers to adopt technology related to health metrics requires a thoughtful and inclusive approach that takes into account their specific needs, concerns, and levels of technological literacy. Here are some strategies to facilitate the adoption of health-related technology among less educated workers:

• Simplify Technology Interfaces:
  Ensure that the technology interfaces are user-friendly and have a simple design. Minimize unnecessary complexity and use intuitive navigation. Use clear language and provide visual aids to make it easy for users to understand and navigate the system.
• Provide Training and Support:
  Offer hands-on training sessions to teach workers how to use the technology effectively. Use a variety of learning methods, including visual demonstrations, practical exercises, and role-playing. Provide ongoing support, such as help desks or tutorials, to address questions and concerns.
• Create Multilingual Resources:
  Recognize language diversity and provide resources in multiple languages to accommodate workers who may not be fluent in the predominant language. This includes user guides, training materials, and support documentation.
• Demonstrate Tangible Benefits:
  Clearly communicate the tangible benefits of using the technology in relation to health metrics. Highlight how it can contribute to their well-being, access to healthcare, or improvement in work conditions. Make the connection between using the technology and positive outcomes.
• Engage Community Leaders:
  Involve community leaders and influencers in the process. Their endorsement can build trust and credibility, making workers more receptive to adopting technology. Consider involving local leaders in training sessions or awareness campaigns.
• Promote Peer Learning:
  Encourage a peer-to-peer learning approach where more tech-savvy individuals within the community or workplace help their colleagues understand and use the technology. This fosters a supportive and collaborative environment.
• Address Privacy and Security Concerns:
  Address concerns related to privacy and security. Clearly communicate how data will be handled, stored, and protected. Assure workers that their information will be kept confidential and used only for the intended purposes.
• Utilize Mobile Technology:
  Leverage mobile technology, as it is often more accessible and familiar to a broader audience. Consider developing mobile applications or solutions that can be easily accessed through smartphones, which are commonly used even in areas with lower technological literacy.
• Incorporate Gamification Elements:
  Integrate gamification elements into the technology to make the experience more engaging. This can include rewards, badges, or friendly competitions that motivate users to interact with the technology consistently.
• Offer Incentives:
  Provide incentives for using the technology, such as discounts, vouchers, or access to additional health-related resources. Positive reinforcement can encourage ongoing engagement.
• Conduct Community Workshops and Events:
  Organize workshops and community events to introduce the technology. Use these sessions to address questions, demonstrate the benefits, and provide hands-on experience. Create a supportive environment where individuals feel comfortable exploring the technology.
• Iterative Feedback and Improvement:
  Collect feedback from users and continuously improve the technology based on their input. This iterative approach helps ensure that the technology evolves to meet the specific needs and preferences of the user community.
• Collaborate with Local Healthcare Providers:
  Collaborate with local healthcare providers and professionals to integrate the technology into existing healthcare services. This collaboration can enhance credibility and facilitate a smoother adoption process.

Successful adoption of technology among less educated workers involves a combination of empathy, education, community engagement, and ongoing support. Tailoring strategies to the specific context and needs of the target audience is essential for fostering a positive and sustainable change.

Exhibit 1: List of responsibilities of an AWW as per Ministry of Women and Child Development19

• To elicit community support and participation in running the programme.
• To weigh each child every month, record the weight graphically on the growth card, use referral card for referring cases of mothers/children to the sub-centres/PHC et cetera and maintain child cards for children below six years and produce these cards before visiting medical and paramedical personnel
• Carry out a quick survey of all the families, especially mothers and children in those families in their respective area of work once in a year
• To organise non-formal preschool activities in the Anganwadi of children in the age group 3 to 6 years of age and to help in designing and making of toys and play equipment of indigenous origin for use in Anganwadi
• To organise supplementary nutrition feeding for children aged 0 to 6 years and expectant and nursing mothers by planning the menu based on locally available food and local recipes
• Wide health and nutrition education and counselling on breastfeeding/infant and young feeding practises to mothers. Anganwadi workers, being close to the local community, can motivate married women to adopt family planning/birth control measures
• AWW shall share the information relating to birds that took place during the month with the Panchayat secretary/gram Sabha sevak/ANM who ever has been notified as registrar/sub registrar of births and deaths in her village
• To make home visits for educating parents to enable mothers to plan and effective role in the child’s growth and development with special emphasis on new-born child
• To maintain files and records as prescribed
• Assist the PHC staff in the implementation of health component of the programme viz. immunisation, health check-up, ante natal and post-natal check et cetera
• To assist ANM in the administration of IFA and vitamin A by keeping stock of the two medicines in the centre without maintaining stock register as it would add to her administrative work which would affect her main functions under the scheme
• Share information collected under ICDS scheme with the ANM however ANM will not solely rely upon the information obtained from the records of AWW
• To bring to the notice of the supervisors/CDPO any development in the village which requires their attention and intervention, particularly in regard to the work of the coordinating arrangements with different departments
• To maintain years and with other institutions (mahila mandals) and involve ladies school teachers and girls of the primary/middle schools in the village which have relevance to her functions
• To guide Accredited Social Health Activists (ASHA) engaged under National Rural Health Mission in the delivery of healthcare services and maintenance of records under the ICDS scheme
• To assist in implementation of Kishori Shakti Yojana (KSY) and motivate and educate the adolescent girls and their parents and community in general by organising social awareness programmes/campaigns et cetera
• AWW would also assist in implementation of Nutrition Program For Adolescent Girls (NPAG) as per the guidelines of the scheme and maintain such record as prescribed under the NPAG
• Anganwadi worker can function as depot holder for RCH kits/contraceptives and disposable delivery kits. However, actual distribution of delivery kids or administration of drugs, other than OTC (Over-The-Counter) drugs would actually be carried out by the ANM or ASHA as decided by the Ministry of Health And Family Welfare
• To identify the disability among children call home visits and refer the case immediately to the nearest PHC or District Disability Rehabilitation Centre
• To support in organising Pulse Polio Immunisation (PPI) drives
• To inform the ANM in case of emergency cases like diarrhoea, cholera etc.

Exhibit 2: List of registers to be maintained at various levels20

Exhibit 3: List of Reports generated by POSHAN tracker21

Exhibit 4: Daily Track of Activities

• Opening of the AWC everyday 
• Attendance records for the AWWs 
• Checklist for children served HCM and morning snacks daily 
• Checklist for health and hygiene of the AWC 
• Checklist for the activities around personal hygiene and pre-school learning performed by AWW and AWCs daily
• Checklist for records about stocks 
• Basic cost detail tracking like rent of AWC and funds received 
• Building use details 
• Building facility details (all features in Exhibit 1)
• Building repair and upgradation details 

Exhibit 5: The State/UT wise details of central funds released and utilised by States/UTs under POSHAN Abhiyaan from financial years 2017-18 to 2020-21 (in Rs Million)22

References

1. Rohatgi, Shivani, Sukhneet Suri, and Praveen Kumar. “Trends of malnutrition from 1947-2021 among under-five children in India.” Current Medicine Research and Practice 11.6 (2021): 269. 

2. http://icds-wcd.nic.in/icds.aspx 

3. https://darpg.gov.in/sites/default/files/ICDS.pdf 

4. https://www.niti.gov.in/poshan-abhiyaan 

5. https://www.poshantracker.in/aboutus 

6. https://thedocs.worldbank.org/en/doc/341341582314668056-0310022020/original/Note1MobileTechnologyforNutrition.pdf 

7. http://icds-wcd.nic.in/icds.aspx#:~:text=Launched%20on%202nd%20October%2C%201975,early%20childhood%20care%20and%20development. 

8. https://pib.gov.in/PressReleasePage.aspx?PRID=1814095