ASHA and ANM workers to be on frontlines of fight against diabetes and cancer

Giving ASHA workers and auxiliary nurse midwives (ANM) a crucial role in the battle against non-communicable diseases (NCDs), the health ministry released protocols for screening and early prevention of hypertension, diabetes and common cancers, at a massive conference on NCDs in New Delhi earlier this week. People across the country will be screened for hypertension and diabetes annually and for cancers of the breast, oral, cervix, every five years.

The guidelines were among a slew of other schemes and surveys that were officially kicked off at the multisectoral conference on June 23. Dr Rajani Ved of the National Health Systems Resource Centre detailed how ASHA and ANM workers would be at the frontline, monitoring the symptoms, habits, and risk factors of each family under their ambit, through a risk assessment checklist. Through posing such questions to families, said Ved, the ASHA and ANM workers would remember who in each household is exposed to which risk factors. Ved called it “health education”. However, a survey of the diseases would not be limited to questions only and everyone above 30 would be” encouraged” to be screened at the nearest health centre.

Emphasising accessibility above all, Ved said that no one should have to travel more than 30 minutes to be screened, privacy will be assured at every health centre and standard protocols will be followed. The state should “prioritise” adequate infrastructure at primary health centres and sub health centres, said Ved, for proper screenings. The aim is for hypertension, diabetes, oral cancer and that of the breast to be screened at the village and sub centre level, which is often a community’s first point of access to health facilities. Cancer of the cervix, that requires Visual Inspection by Acetic Acid (VIA) test, will be offered at the primary health level, and ANM workers need to be trained to carry it out. 

Ved said that if ANM workers at sub centres can be trained for VIA then even those are an option. “We know from global studies that population based screening isn’t always the best way,” said Ved, “but in our context, where health seeking behaviour is so poor, we will be doing population based screenings for the first few years.”

Early prevention is crucial to halt the rising tide of lifestyle diseases, estimated to cause 60% of deaths in India. However, for such a scheme to succeed, India needs to strengthen its rural health infrastructure. According to the Rural Health Statistics 2015, “there are 153655 Sub Centres, 25308 Primary Health Centres (PHCs) and 5396 Community Health Centres (CHCs) functioning in the country. While the Sub Centres, PHCs and CHCs have increased in number in 2014-15, the current numbers are not sufficient to meet their population norm”. The shortfalls in ANM staff is not as bad as there is in the number of doctors posted. However, “the number of ANMs at Sub Centres and PHCs (Statement 14) has decreased from 2,13,400 in 2014 to 2,12,185 in 2015 (decrease of 1,215). Major reductions are observed in the States of Maharashtra (466), Tamil Nadu (619), Jammu & Kashmir (292), Rajasthan (259), Tripura (185) and Madhya Pradesh (168).”

Even though the numbers are not noticeably alarming, for ensuring accessibility to all, and a thorough screening process, states will have to respond to their individual shortages on a war footing.