Understanding a program for providing preventive screening services for women of Dharashiv District, Maharashtra
Author: Dr. Shirish Ghadi (Specialist Health, Transform Rural India), Dr Priya A Chauhan (MD OBGYn, Founder-Director of Mangal Pratap Stree Arogya Kendra)
Screening for Non-Communicable Diseases (NCDs) has been a part of the activities of the public health department in India as per the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes (NPCDCS) since 2015, despite this the coverage for screening of women for the cervical, breast and oral cancers was at 4.3%, 0.0%, and 0.0% in Dharashiv (erstwhile Osmanabad) district respectively as per the National Family Health Survey-51. Risk assessment of a majority of the population is done through a Community-based Assessment Checklist, however, the checklist data is not analyzed at the peripheral level to prioritize the mobilization of at-risk populations for screening. In response, Mission Anandi was launched on the occasion of World Health Day 2023 in the Dharashiv District of Maharashtra state by Mr. Rahul Gupta, the then CEO (Chief Executive Officer) of Zilla Parishad, Dharashiv. Through this program, screening of women aged 30 years and above for six ailments, namely, Anemia, Hypertension, Diabetes, Oral, Breast, and Cervical cancer was facilitated.
The Dharashiv district administration2 in partnership with the Transform Rural India (TRI) Foundation successfully screened 1 lakh women in the district for cervical cancer using the VIA (Visual Inspection with Acetic Acid) technique. 50 women were diagnosed with suspected minor lesions and cervical cancer, and four women were diagnosed with breast cancer through this program. Tools developed by NIRAMAI Health Analytix were used in this program and women identified with these lesions were treated at the Nargis Dutt Cancer Institute in Solapur city3.
As, a Specialist Health at TRI, in my view, the following were the challenges and subsequent learnings we encountered during this program in the different phases.
Pre-screening phase
- Organizing the availability of instruments and disposables for VIA screening was one of the primary tasks.
- Training of staff for screening of cervical, breast, and oral cancer had to organized—In this regard, Dr. Priya Chauhan, Founder-Director of Mangal Pratap Stree Arogya Kendra, conducted a workshop to train the health staff at the Women’s Hospital in Dharashiv in June 2023 in VIA and breast examination.
- Awareness amongst females regarding the availability of screening facilities for oral, breast, and cervical cancer at the subcentres and PHCs was low
Screening phase
- Strategic mobilisation of women so as to reduce the waiting time and follow proper disinfection measures was a challenge.
- Availability of instrument for VIA was a concern, despite instructions given to procure adequate number of screening instruments, there were screening facilities which had only one or two Cusco’s speculum, which meant either improper disinfection of instrument when they came in huge numbers for screening or not screening every woman that has visited.
- Weekly review of performance of the facilities at all levels based on analysed data was done to chart progress
- Reporting of data: The daily screening count did not match the line list maintained at the screening facility.
- Online reporting in the NCD portal: Only 35% of the actual screened female’s data was updated on the online NCD portal
- Quality of screening: While speaking with the beneficiaries, a few females said that breast screening was not conducted on them if they did not have any symptoms.
Post-screening phase
- Access and Availability of Diagnostic services for suspected cases at the secondary and tertiary facilities was lacking
- Referral pathway was shared with every facility so as to cut-down the delays post screening
- Health education of every female visiting the facility for screening on what risk factors to address to reduce the risk of cancers
- Nutritional counsellingwas provided
- Activation of weekly NCD clinic at the PHC and subcentre to make the NCD initiative sustainable and less dependent on a camp-based approach to meet the targets will be vital to sustain the screening program
References
1. National Family Health Survey-5 District Fact sheet-Osmanabad. Government of India, Ministry of Health and Family Welfare; 2019.
2. Mission Anandi District Osmanabad – Rahul Gupta IAS | Rahul Gupta IAS [Internet]. [cited 2024 Apr 17]. Available from: https://rahulguptaias.com/mission-anandi-district-osmanabad-rahul-gupta-ias/
3. Mission Anandi – reaching rural women with AI-enabled health checks – TRI – Transform Rural India [Internet]. 2023 [cited 2024 Apr 17]. Available from: https://www.trif.in/mission-anandi-reaching-rural-women-with-ai-enabled-health-checks/