PremiumBENGALURU : Sangeeta Kamble migrated to Mumbai from Kolhapur in 1997, a few years after her wedding in order to live with her then unemployed husband. She then began working in the nursing sector, drawing a meagre salary. By 2006, she had registered herself as an Anganwadi worker (frontline staff who manage India’s child nutrition programme, which is among the largest of its kind in the world).
The salary was certainly better, but the real draw, Kamble says, was the job satisfaction. Her monthly income of ₹8,500 allowed her to pursue higher education and take care of her two school-going children. But things have been unstable for some months now.
The sudden introduction of a smartphone application—Poshan Tracker—into the daily workings of a job that she had perfected for more than a decade became a deterrent rather than an enabler, forcing her to rally against the government on the streets of Mumbai on 27 August. Dressed in pink uniform, Kamble was among the roughly 150 Anganwadi workers who had gathered in Mumbai to protest the sloppy government-given smartphones that they have to use for their daily work now. The health and childcare workers boxed up the devices as a sign of protest and wished to return it, chanting “Mobile vaapsi andolan zindabad" in unison.
“Many of these mobile phones already didn’t work properly—changing colour when we plugged it in for charging; getting too hot; getting switched off," said Kamble, 48, who received a mobile phone from the government some two years ago. “And now, the memory in the phone isn’t enough for us to use this Poshan app properly. It also has several glitches, and we have to enter details in English. I have studied in Marathi medium."
Poshan Tracker, a smartphone application launched in January and made mandatory in March 2021, helps Anganwadi workers record all their daily activities—including marking attendance for themselves and the beneficiaries, entering details of the nutrition services and uploading images of the activities conducted for children and mothers. But workers are facing technical glitches while uploading or deleting entries. In many cases, the low-specced Panasonic devices with 2GB RAM (random access memory) did not let them download the 35 MB (megabytes) application—the same size as the YouTube app, which is a common app on most Android phones.
Digital healthcare experts and Anganwadi union workers say this incident ties into the government’s theme of regularly looking at digitizing activities of rural healthcare workers without taking into account the on-ground challenges such as tech literacy, smartphone availability and internet connectivity.
“This is just digitization without actually addressing the real problem of malnutrition," said A. R. Sindhu, general secretary of the All India Federation of Anganwadi Workers and Helpers.
“If the government sincerely wants to track (nutritional services), then they should take some time, need to make a foolproof system and (then) roll it out stage by stage. Right now, the local offices are not equipped to handle this," added Sindhu.
This unfolding confrontation between childcare workers and the government’s tech-centric vision couldn’t have come at a worse time. Anganwadi workers are already walking a tightrope, managing both nutrition and covid-related duties. The pandemic has put more children at the risk of malnutrition and with the mandatory app causing frequent technical glitches, food distribution among children could get hindered.
Moreover, with the Anganwadi workers spending more time to understand the app rather than focusing on their other duties, the issue could have a long-term impact, say healthcare experts. “The nutrition programmes have already suffered immensely during the pandemic, and they need to be brought back on track," said Anant Bhan, an independent researcher with experience in the fields of global health, bioethics and health policy. “Switching to a tech-based platform entirely without ironing out the glitches is only going to make it difficult for them (the schemes) to function effectively."
Malnutrition-free India
It is 9 am at the Anganwadi centre at Pragpur village in Punjab, some 20 km from Chandigarh, and its worker, Sarabjeet Kaur, dressed in a bright blue salwar kameez, is busy juggling multiple registers—one of them is to enter details of the ration that is distributed to the homes that fall under her centre. “Because of the lockdown, we don’t have children coming to the centre, so we spend all our time doing paperwork these days," said Kaur, 39, who has been an Anganwadi worker for the past 15 years. Most of her work continues to be manual, but at the end of every month, she uses her personal smartphone to upload her progress report on the Integrated Child Development Services (ICDS) website. But because of the patchy internet connectivity in her village, it can sometimes take “half an hour or more to upload a single picture or a report on the website."
Kaur is among several other Anganwadi workers from Haryana and Punjab who refused to install the Poshan Tracker app. Thousands of Anganwadi workers protested in these two states, asking the government to either make arrangements for new smartphone devices or roll back the mandate, after an order issued by the Union women and child development ministry in March threatened to cut their pay if they don’t start using the mobile application. “They haven’t given us smartphones and 80% of (the) workers in our villages can neither afford a smartphone nor do they understand how to use them," said Gurpreet Kaur, 50, another Anganwadi worker in Dhanauni village in Punjab. Gurpreet usually goes up to her terrace or travels two kilometres to the nearby Dera Bassi bus stand to upload the monthly progress report or images from celebrating Poshan Divas at her Anganwadi centre using her personal smartphone. “During the winter, it’s really bad. I have to stay on the terrace in the freezing cold while I upload the report," she adds.
The Union government led by Prime Minister Narendra Modi launched Poshan Abhiyaan, a flagship national nutrition mission in 2017, with an aim to attain “malnutrition-free India by 2022." With 14% of India’s population being undernourished and the country ranking 94 of 107 countries in the Global Hunger Index in 2020 (with a ‘serious’ level of hunger), Poshan Abhiyaan became an imperative mission and Anganwadi workers became an important medium to attain the goal to eliminate malnutrition.
For this purpose, the government implemented a real-time monitoring system—Common Application Software or CAS—to track the service delivery by Anganwadi workers and ensure better supervision of the government’s schemes for young children and new mothers.
Kamble from Mumbai was one among the several Anganwadi workers who first used CAS in 2018 on the mobile phones given by the government. While that application also had technical issues, Kamble said it helped them with their daily work immensely. “That was in Marathi. Whenever we did a survey of pregnant women, children and entered all the details, the app would automatically show who needs nutrition services, who needs to be hospitalized, etc," recalled Kamble. “Earlier, we had to maintain 10-12 registers, but this app helped reduce the workload."
But in 2020, the covid-19 pandemic happened and the CAS app was also revoked, she added. Then, in early 2021, the Poshan Tracker app was launched to record the real-time delivery of services by 1.4 million Anganwadi workers in India to 100 million beneficiaries.
Since March, the Centre says that more than 1.3 million Anganwadi workers across India have registered with the app. “The purpose of POSHAN Tracker application is to provide a 360-degree view of the activities of the Anganwadi Centre (AWC), service deliveries of Anganwadi Workers (AWWs) and complete beneficiary management for pregnant women, lactating mothers and children," reads the website. Its dashboard provides crucial data—a breakdown of registered workers and beneficiaries, their attendance, and ration and cooked meals given on a specific day. The government documents further say that the app will be compatible in 12 languages, but this hasn’t yet reflected on ground.
The app is compatible with Android 6 devices, but most workers in Maharashtra claim the Panasonic phones given to them aren’t able to handle the load of the mobile application. “When the workers got a message on their phones that they are unable to download this app, their superiors asked them to download it on their personal phone," said Shubha Shamim, vice-president of the All India Federation of Anganwadi Workers and Helpers. “As if this is a need for the worker and not the government."
Several workers have had to shell money out of their own pockets to get the phone repaired, which sometimes cost up to ₹4,000—almost half of their monthly salary. “Many of them even removed all the other apps from their phone and downloaded Poshan Tracker, but the uploading of data sometimes takes 5 to 6 hours," added Shamim. This becomes doubly difficult because most low-income families have one smartphone for the entire family, rather than one per person, which is the case with urban families.
Apart from the pressure to install the Poshan Tracker app, Anganwadi workers say they are burdened with the government asking them to constantly upload pictures of all their activities, which includes everything from a baby shower for the pregnant woman in their village to home visits, among others. “They keep asking us to click pictures," said Usha Rani, president of All India Federation of Anganwadi Workers and Helpers. “It’s like they (the government) look at Anganwadi workers with a suspicious eye. We have to click a picture for every step we take to prove that we are doing our work." Rani has been an Anganwadi worker for several decades now and is one of the main union workers heading the protest in Haryana and Punjab.
Sukhdeep Singh, the nodal officer for Poshan Abhiyaan in Punjab, says that they are currently in the process of procuring smartphones for Anganwadi workers and it will end up taking some 3 months. “Our specifications have been finalized and now we will go for the bidding process," said Singh, explaining how each state procures these devices. “We don’t have a choice on the smartphone we can procure. It’s a very transparent, online bidding process on the GeM (Government e-Marketplace). You can only finalize the specifications of the smartphones; you cannot select the brand or the OEM (original equipment manufacturer) which we are going to purchase."
The Union ministry did not respond to emails seeking comment.
Techno solutionism
In the last few years, the Centre and several state governments have repeatedly imposed the use of technology on various low-income workers, including sanitation workers in Pune and Asha workers in Haryana. Even the mandatory use of Aadhaar has caused several on-ground challenges in rural areas, making it difficult for citizens to claim government benefits at times.
Experts who are working on using tech to enable rural healthcare workers believe that enforcing such technologies on healthcare staff such as Anganwadi workers is bound to shift their practices drastically by moving them from care-workers to compliant data-collectors. “Anganwadi workers are already perceived from the top as people who do ‘menial’ data collection work, and that they need to be monitored and supervised," said Naveen Bagalkot, an interaction design researcher at Srishti Manipal, who works on designing systems for rural healthcare workers.
The technology-centric solution also takes place under the assumption that smartphones and 4G networks are easily available and accessible. Bagalkot further says there are other ways to use technology and enable healthcare workers in a way that aids their work.
“We should do this by working with the workers and their unions to collaboratively build, pilot and demonstrate technologies that augment care work and offer ground-up alternatives of technology to push back at the policy level on these top-down imaginations," he added.
The state-wide Maharashtra rally has concluded with almost 80% of the over 100,000 workers having returned their phones. But things continue to stay in limbo. “Workers [in Maharashtra] are saying they don’t want the mobile phones, they don’t want the Poshan Tracker app," said Shamim. “They are happy going back to their manual registers."
Reporting for this story was supported by the Pulitzer Center
