The Ayushman Bharat Scheme upgraded primary health centres to Ayushman Bharat Health and Wellness Centres (HWCs). These Ayushman centres were supposed to offer annual screening for those who were 30-plus for non-communicable diseases (NCDs) – hypertension, diabetes, and three of the most common cancers in India, oral, breast and cervical cancer.
The Ayushman Bharat insurance scheme has become the world’s largest medical insurance scheme. But when it comes to cancer screening, there is a “huge gap,” according to a report from 13 states prepared by NITI Aayog, the government think tank.
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 that it will “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.
The gaps have been attributed to “low levels of awareness,” and “lack of capacities”. The report said that yearly screening for NCDs was not taking place. In fact, The HWC staff were unaware that screening for hypertension and diabetes needed to be done annually, according to the report.
Niti Aayog teams
The report, prepared by Niti Aayog’s Health and Family Welfare vertical in June last year, has not been made public yet. It is learnt that its findings have been shared with the Ministry of Health and Family Welfare.
NITI Aayog teams reportedly visited 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 functioning of the centres.
The states include Andhra Pradesh, Bihar, Gujarat, Haryana, Jammu & Kashmir, Kerala, Madhya Pradesh, Maharashtra, Odisha, Rajasthan, Sikkim, Tripura, and Uttar Pradesh.
Niti Aayog decided to conduct a fresh “evaluation” of the HWCs in March this year. It has invited proposals from national and international firms for this purpose.
There are three methods of screening for the three cancers: oral visual examination for oral cancer; visual inspection with acetic acid for cervical cancer; and clinical breast examination (CBE) for breast cancer for the people in the age group 30-65 years.
Lack of training
Auxiliary Nurse and Midwife (ANMs) at the HWCs were meant to be trained in these three screening methods as were medical officers and staff nurses. However, this has not happened to the extent expected.
People have been asked to undertake self-examination for breast cancer screening. The provision for screening of cervical cancer is yet to be operationalised. Screening for oral cancer is performed on a case by case basis, depending on tobacco consumption habits or visible symptoms, according to the report.
On infrastructure in the HCWs, the news is 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.
