Niti Aayog report finds ‘huge gap’ in cancer screening at Ayushman centres
BESIDES the Rs 5-lakh insurance cover, the flagship Ayushman Bharat Scheme envisaged the upgrade of primary health centres to Ayushman Bharat Health and Wellness Centres (HWCs). These would, among a range of services, offer annual screening for those 30 years or older for Non Communicable Diseases: hypertension, diabetes, and three of the most common cancers in India — oral, breast and cervical.
Six years since the launch, the Ayushman Bharat insurance scheme has been availed of by more than 5.47 crore users across the country — making it the world’s largest medical insurance scheme. But when it comes to cancer screening at the HWCs, there is a “huge gap,” according to a report from 13 states prepared by NITI Aayog, the government’s premier policy think tank, The Indian Express has learnt.
This report was prepared by Niti Aayog’s Health and Family Welfare vertical in June last year. It has not been made public yet. It is learnt that its findings have been shared with the Ministry of Health and Family Welfare.
It is learnt that three-member teams of NITI Aayog visited a total of 93 HWCs across 37 districts in 12 states and one Union Territory over a period of four months (from mid-December 2022 to early April 2023) to track the progress and functioning of the HWCs. The states include Andhra Pradesh, Bihar, Gujarat, Haryana, Jammu & Kashmir, Kerala, Madhya Pradesh, Maharashtra, Odisha, Rajasthan, Sikkim, Tripura, and Uttar Pradesh.
Niti Aayog has decided to conduct a fresh “evaluation” of the HWCs – in March this year, it issued a Request for Proposal (RFP), inviting proposals from national and international firms for this.
When contacted, an official declined to comment but said that the gap is attributable to “low levels of awareness,” and “lack of capacities.”
As per official protocol, there are three distinct methods of screening for the three cancers: oral visual examination for oral cancer; visual inspection with acetic acid for cervical cancer (under this, the cervix is examined after the appliciaton of 3-5% acetic acid); and clinical breast examination (CBE) for breast cancer for the people in the age-group 30-65 years.
Under the Ayushman upgrade, Auxiliary Nurse and Midwife (ANMs) at the HWCs were meant to be trained in these three screening methods. Also planned was the training of Medical Officers and Staff nurses. “These require intensive training and careful monitoring to sharpen the screening skills. This hasn’t happened to the extent that was expected,” said an official.
“Screening for breast cancer is being administered by educating beneficiaries to undertake self-examination. Provision for screening of cervical cancer is yet to be operationalized. Screening for oral cancer is performed on a case by case basis, depending on tobacco consumption habits or any other visible symptoms. Presently, suboptimal cancer screening activities are a huge gap,” the report noted.
The report also flagged that although NCD screening was underway at most facilities, yearly screening was still largely absent.
“All of the facilities visited have been functional over a year, however less than 10% facilities had completed a single round of NCD screening in the population,” the report said.
The NITI Aayog teams also found that the HWC staff had limited or no knowledge of the fact that the screening for hypertension and diabetes needed to be done on an annual basis.
On infrastructure in the HCW, the news was better. The report said that it was in accordance with standards as envisaged in the operational guidelines. All basic devices such as stethoscope, BP apparatus (digital), weighing scale (adult and infant), clinical thermometer (oral and digital) were available and functional, it said. Medicines and diagnostic tests were available free-of-cost in all the visited facilities, it added.
The gaps in cancer screening are significant in view of the government’s focus on prevention and detection of cancer at an early stage. In its manifesto, the ruling BJP has announced to “expand the existing health services focussed on the prevention and reduction of Anaemia, Breast Cancer, Cervical Cancer and Osteoporosis, ensuring a healthy life for women.” The party has also announced that it will launch a “focused initiative to eliminate” cervical cancer.
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