(P28-039-23) Building Capacities of Community Health Workers To Improve Nutrition Outcomes in Rural India: A Knowledge Attitudes Practices Framework

Objectives: Health and nutrition data in India reveal continued poor outcomes with stark geographical differences in nutritional indicators.The state health and welfare apparatus rely on Community Health Workers (CHWs) - Accredited Social Health Activists and Anganwadi Workers, part of the National Health Mission and Integrated Child Development Services respectively, to deliver national schemes in more vulnerable rural and remote contexts. These CHWs act as social brokers mobilising rural communities vis-a-vis the public health system, mediating access to health information and services. Yet there exist inadequacies in CHWs’ training contributing to gaps in knowledge and contextually-relevant practices.In this study, we seek to understand the readiness of the CHWs to tackle the issue of malnutrition, particularly amongst women and children, by assessing their health and nutrition knowledge, attitudes, and practices with a view to strengthening policies to build CHW’s capacities and their impacts on the ground.

Methods: The study was conducted in the Santhal Pargana region of Bihar and Jharkhand, known for high malnutrition levels. The FAO’s nutrition-related knowledge, attitudes, and practice survey was administered among 77 CHWs from January to April 2021 to assess responses across six modules: nutrition during pregnancy and lactation, undernutrition, iron, and vitamin deficiencies, food safety, and COVID-related preparedness.

Results: Knowledge across modules ranged between medium to high and attitudes scored high. However, practices were consistently low to medium. On undernutrition, 81% of ASHAs had high knowledge, yet 65% could not articulate practices utilising local resources to address it.

Conclusions: Lower adoption of context-appropriate practices indicates a gap in basic capacity levels of CHWs. Our study reveals their underutilised potential as key interlocutors between communities and the state health system due to a lack of attention to contextual practices and listening to local needs at the policy level. By empowering them and training them to respond to context-specific concerns especially around access to local micronutrient-rich food, CHWs can build a bottom-up networked rural health infrastructure to sustainably improve nutritional outcomes.

Funding Sources: EPSRC Global Research Translation Award (EP/T015411/1UKRI)