An executive summary of the programme is described below.
Charutar Arogya Mandal (CAM) is a not for profit organisation founded by the late Dr. H.M. Patel in 1972, with the purpose of providing quality health care services to the rural community of Charotar – Anand and Kheda districts of Gujarat. Shree Krishna Hospital (SKH) set up by the CAM in 1981, is now a 800 bedded medical college hospital that provides tertiary level health care facilities to the community. It has a well established cancer centre since 2004, equipped with all the latest technologies for treatment of cancer patients. The Founder Chairman of the CAM had a vision to ensure that the health care services provided by the CAM do not remain confined only to the hospital, but are extended to the community as well. To fulfill the vision, CAM is involved in several community based health care and health promotional activities. CAM operates eight Extension centres with the purpose of extending health care services to the community in the nearby regions and runs a grass root level health programme in 27 villages located nearby, wherein a lady is identified from each of the villages and trained as a Village Health Worker (VHW). To address the problem of cancer in the region, a Cancer Awareness, Early Detection and Treatment program was started by the CAM in 1999 in two districts of Gujarat viz. Anand and Kheda. In this program, a health work force of Village Health Workers in around 600 villages was created. They were trained in creating awareness on cancer and in the identification of early signs of cancer and de-addiction.
At present, India is undergoing an epidemiological transition wherein the burden of noncommunicable diseases (NCDs) is increasing. The NCDs are responsible for 53% of total deaths and 44% of the Disability Adjusted Life Years (DALYs) lost. Among all the non-communicable diseases, cancer contributes to 0.63 million deaths every year accounting for 6% of all deaths in India. The morbidity caused by cancer is responsible for loss of around 8.7 million DALYs, second only to Ischaemic Heart Disease – 14 million and more than stroke – 6 million and diabetes – 2million. Among all the cancers, cancers of oral cavity and lungs in males and cervix and breast in females account for more than 50% of all cancer deaths in India. To address the problem of cancer, the Government of India is running a National Cancer Control Programme, but the on-field scenario is quite dismal in the area of cancer prevention and control. There is a lack of standardized strategies for information, education and communication (IEC) and screening procedures, diagnostic and therapeutic services are limited and mostly restricted to urban areas and there are issues related to quality, accessibility and cost. Palliative care services are inadequate to meet the demands of the terminally ill patients.
CAM has the experience of running a community based cancer programme and the expertise for providing cancer treatment. This expertise and experience can be combined to develop a model community based cancer prevention and control programme which addresses all the issues related to cancer prevention and control ranging from prevention of risk factors to provision of palliative care to terminally ill patients through an integrated approach. Moreover a Population Based Cancer Registry will also be established to provide the much needed valuable data related to cancer at the state and national level and serve as an evaluation tool for the newly proposed programme. The programme can serve as a source of reference for the Government and other Non-governmental agencies working in the field of cancer control.
The objectives of the proposed programme will be to reduce the occurrence of new cancer cases in the community by addressing two important risk factors viz. addiction (for oral cancers) and poor genital hygiene (cervical cancer), detection of cancer cases in early stages and facilitating them in availing appropriate treatment, providing palliative care and relief to the terminally ill cancer patients in the community and documentation and dissemination of the work done under the programme. The programme will be implemented in 90 villages in a phased manner over a period of three years in two phases. A Village Health Worker (VHW) will be identified in each village and will serve as the focal point for implementation of the programme. Phase 1 activities will include building rapport with community, treatment of common ailments by VHW, capacity building of staff , conducting household survey, creating tobacco free zones, Health education by VHW and FS for high school children, training of adolescent and Sakhi-mandals, sensitisation session for school teachers and creating support groups in the village. In the second phase starting from the second year onwards, programme activities such as cancer screening and palliative care will be undertaken. The work of the VHWs will be supervised by Field Supervisors. A public health nurse will visit each of the village once in a month and will provide services such as de-addiction, screening and palliative care through a camp based approach. Those persons requiring further care and support will be referred to the Extension Centres located nearby. Those patients requiring further care and support will be referred to Shri Krishna Hospital for management. A programme Management Information System (MIS) will be established to monitor the indicators reflecting the performance of the programme such as incidence of cancer, prevalence of cancer, cancer mortality, etc. PBCR and Verbal Autopsy systems established as a part of the programme will provide valuable data for the MIS.
Tobacco is one of the risk factor which causes financial burden to households and risk to suffer from cancer like catastrophic disease.
| Sr. No | Activity | Description of activity | Outcome( Feb2014- Jan 2015) |
|---|---|---|---|
| 1 | School Session on Tobacco Control | To Increasing awareness among school children regarding hazards of addiction a school session is organised in schools. TC session has been conducted with class 6th std students. From our field experience we have found that children start using at very early stage. Once the children addicted to tobacco , it is very difficult to quit due to various social issues like lack of proper health education, fear of threatening from elders , peer pressure etc. | 52 sessions has been conducted. |
| 2 | Peers Session ('Aapno Mitra') | (Aapno Mitra- YOUR FRIEND) is the name of the programme which is offered to 10-15 creamy students of 6th std. The screening is done with the assistance of teachers who closely work with students. The Peers also pledge that they will never use any tobacco product neither they will promote or let promote tobacco product in their vicinity. | 20 session has been conducted. |
| 3 | Sakhi Mandal/Bhajan Mandal Session | Sakhi Mandal sessions has been conducted on tobacco control. | 54 women groups were trained for promotion of tobacco free environment. |
| 4 | Principal/Teacher Session | School teachers interact with students
the most. Its quite unlikely that students
would try / take up tobacco if school
teachers argue against tobacco usage
and simultaneously demonstrate it in
their own practice. A day workshop was conducted where following points were covered i.e. Hazards of tobacco, Role of teachers towards tobacco de-addiction and a panel discussion was organised to discuss practical problems while creating a tobacco free environment in and around the schools. |
37 schools teachers and principals participated in workshop. |
| Sr. No | Activity | Description of activity | Outcome( Feb2014- Jan 2015) |
|---|---|---|---|
| 1 | Train adolescent girls of school on menstrual health | Adolescents girls has been trained on menstrual health topics by trained Medical Social Worker (MSW). Geeta Story, a flip chart is widely used as a supporting communication mode for increasing interaction among girls. Maximum possible questions are covered in sessions. | 53 sessions has been conducted. |
| 2 | Poster on Menstrual Health | Posters have been displayed to Anganwandi and sub centres for promotion of menstrual health. | Posters had been displayed in 46 villages. |
| Sr. No | Activity | Description of activity | Outcome( Feb2014- Jan 2015) |
|---|---|---|---|
| 1 | Train Sakhi Mandals in promotion of genital hygiene and self breast examination | Sakhi Mandals were trained on topic cervical cancer and breast cancer. A breast manikin is used for hands on training for early diagnosis. | 53 sessions were conducted. |
| Sr. No | Activity | Description of activity | Outcome( Feb2014- Jan 2015) |
|---|---|---|---|
| 1 | Cancer Screening Camps | Cancer Screening camps are organised in 26 programme villages in first year. The at risk patients are identified through the HH survey and referred to the camps. The risk criteria are- Oral screening- Anyone who is a tobacco addict Clinical Breast Examination- Any female in age bracket of 35-60 years Cervical screening- Any female in age bracket of 35-60 years | 130 cancer screening camps were organised in February 2014 -January 15 |
Effectiveness of a community based NCD(Non- Communicable) care programme supported by Integrated Voice Response System (IVRS) for management of Hypertension and Diabetes Mellitus in a rural population of Gujarat.
