Frontline Functionaries and Beneficiaries' Perceptions on the Integrated Child Development Services (ICDS) Scheme in rural Etawah, Uttar Pradesh: A Qualitative Study

Background: The Integrated Child Development Services (ICDS) scheme is a key component of India’s maternal and child health framework. Understanding the experiences of frontline workers and beneficiaries is essential for improving implementation and service delivery. This study assessed the knowledge, practices, and institutional barriers faced by Anganwadi Workers (AWWs), alongside the lived experiences and perceived challenges among rural beneficiaries in District Etawah, Uttar Pradesh. Aim: To assess the knowledge, field practices, and institutional barriers faced by Anganwadi Workers (AWWs) alongside evaluating the lived service experiences and perceived obstacles of community beneficiaries in rural areas of district Etawah. Material & Methods: A cross-sectional qualitative study was conducted using Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs) guided by a critical realist framework and inductive thematic analysis. Data were collected from four rural blocks through 40 IDIs with AWWs and 06 FGDs involving pregnant women, lactating mothers, and adolescent girls. Structural thematic analysis with line-by-line open coding was performed manually. Transcripts were evaluated manually utilizing structural thematic analysis via line-by-line open coding and inductive theme generation. Results: Anganwadi workers faced severe workload burdens due to an unfunded digital transition, dual documentation, and systemic app errors, while inadequate facilities and mandatory photo verification discouraged beneficiaries who viewed the centres strictly as ration hubs. Furthermore, adolescent girls reported low awareness of the Kishori Shakti Yojana. Conclusion: Rural ICDS implementation faces substantial operational and socio-cultural barriers. Strengthening infrastructure and developing culturally sensitive, stakeholder-informed multimodal interventions are essential to improve service delivery and beneficiary engagement.