Community Based Mobile Screening Programme for Oral, Breast and Cervical Cancers: A Programmatic Insight from rural Assam, India

Abstract

The Kamrup district in Indian state of Assam has highest cancer incidence. The population, particularly in rural area has no access and resources for early cancer screening and care services. To fill this service gap, a not-for profit organization (Piramal Swasthya Management and Research Institute-PSMRI) in collaboration with semi-government institute (Dr. Bhubaneshwar Borooah Cancer Institute, Guwahati-BBCI) launched an innovative programme known as DESH (Detect Early, Save Her & Him) in rural Kamrup. The programme aims to reduce the proportion of late-stage diagnosis and mortality from oral, breast and cervical cancers through community-based awareness, screening and referral program. During first year of program operations (November 2017 to June 2018), DESH screened 3937 beneficiaries across 96 villages in three blocks of rural Kamrup district. Out of the total screened population, 157 (4.0%) are initial screen positive (Oral 142; breast 7; cervix 8.) Out of all screen positives, only 62 visited the BBCI for further diagnosis and confirmation. Among screen positives, 4 beneficiaries are confirmed oral cancer cases (all male, 3 in stage 1; 1 in stage 3). Ensuring continuous availability of doctors, greater public engagement and building community awareness of common cancers are some of the identified areas for improvement. In the long run, we see our program as an opportunity to build an evidence-based, cost-effective and replicable model for early detection of Oral, Breast and Cervical Cancers in resource-scarce settings.

Improving access to cancer care among rural populations in India: Development of a validated tool for health system capacity assessment

“…Given all the opportunities as well as the weaknesses of the existing health systems in providing cancer early detection services that are accessible, affordable, acceptable, and effective, the HSCA tool developed by us will be of great value for each of the Indian states to reorganize cancer care. The primary objective of the ACCI implementation research project is to design and evaluate a new multi‐level strategy, integrated and contextualized to the local health system, to improve access to the early detection and care continuum for oral, breast, and cervical cancers among rural populations in India 15 . Thus, a dedicated tool is fundamental to assess the capacity of the health system and understand its readings toward intervention implementation.…”

“…In this context, the Access Cancer Care India (ACCI) project (https://accesscancercare.in/) 14 aims to investigate implementation barriers at the levels of individuals, providers, and health systems in order to design and evaluate a new multi‐level strategy that is integrated and contextualized into the local health system, and to eventually improve access to the early detection and care continuum for oral, breast, and cervical cancers among rural populations. This implementation research project will be conducted in three sequential phases entailing a situational analysis, designing context‐appropriate new strategies through stakeholder engagement, and evaluation of the new strategies using implementation research outcomes 15 . Toward identification and evaluation of the abovementioned strategies, a thorough understanding of local health systems is fundamental.…”