C THE SIGNS

Government must heed alarm bells in Niti Aayog report that flags gaps in cancer detection

IT’S WELL-KNOWN THAT spotting signs of cancer at an early stage significantly increases the possibilities of surviving the disease. In India, government projects, including the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke, recognise this necessity. These programmes have given special emphasis to checking for cervical, oral and breast cancers — they constitute a third of all cases of the disease in the country — before symptoms appear. Yet, successive National Family Health Surveys have revealed that a very small percentage of people in the vulnerable age group — those over 30 years of age — get screened for malignancy. Turning 1,50,000 health and wellness centres (HWCS) into nodal points for cancer detection under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) could have proved to be a game changer. The introduction of screening facilities at these primary healthcare centres could have reduced accessibility-related problems to a great extent. But a Niti Aayog report has flagged “huge gaps” in the performance of these HWCS. Less than 10 per cent of these centres had completed one round of screening for noncommunicable diseases, including cancer, says the report.

In recent years, India has done well in piloting low-tech approaches to cancer screening that can be delivered at scale by community-level workers. AB-PMJAY makes use of these technologies. Global experience shows that the trust enjoyed by grassroots-level professionals is a big positive when it comes to screening people for diseases that may not show any symptoms. The government, therefore, did the right thing in roping in ASHA workers in its project. However, it does not seem to have invested adequately in the next steps. Given the low awareness of the disease, it was imperative that these frontline professionals were educated about cancer prevention protocols and trained to use the screening techniques. Much before the NITI Aayog’s study, analyses conducted with smaller sample sizes had underlined that ASHA workers should be sensitised to risk factors, symptoms and, in fact, the need for screening itself. These studies also emphasised the need to improve the working conditions of these low-paid and overburdened workers. The ABPMJAY also refers to such imperatives. The NITI Aayog’s study underlines that the upgrades have not been undertaken in adequate measure.

The Union Ministry of Health has designated the Noida-based National Institute for Cancer Prevention and Research as a training hub. The institution’s expertise must be summoned for screening malignancy. Experts agree that such instruction can be given online and professionals receiving such training can educate others. Reducing India’s cancer burden will require efforts in several directions. The Centre must take the right lessons from the report of the Niti Aayog.