Is India's public health care system prepared for cervical cancer screening?: Evaluating facility readiness from the fourth round of the District Level Household and Facility Survey (DLHS-4)

• Type of Material: Article
• Authors: Preet K. Dhillon, Public Health Foundation of India; Benjamin D. Hallowell, Centers for Disease Control and Prevention; Sutapa Agrawal, Public Health Foundation of India; Arpita Ghosh, Public Health Foundation of India; Awdhesh Yadav, Public Health Foundation of India; Elizabeth Van Dyne, Centers for Disease Control and Prevention; Virginia Senkomago, Centers for Disease Control and Prevention; Shivani Patel, Emory University; Deepika Saraf, Indian Council of Medical Research; Roopa Hariprasad, National Institute for Cancer Prevention and Research, India; Neha Dumka, National Health Systems Resource Center, New Delhi; Ravi Mehrotra, India Cancer Research Consortium, New Delhi; Mona Saraiya, Emory University
• Language: English
• Date: 2020-09-01
• Publisher: Elsevier Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ypmed.2020.106147
• Title of Journal or Parent Work: Preventive Medicine
• Volume: 138
• Start Page: 106147
• End Page: 106147
• Grant/Funding Information: The study was supported by the U.S. Centers for Disease Control and Prevention (CDC) through its cooperative agreement (5NU380T000203-04) with the National Network of Public Health Institutes (NNPHI) and sub-award to the Public Health Institute (PHI).
• Keywords: Screening; Medicine, General & Internal; India; Cervical Cancer; General & Internal Medicine; Science & Technology; Public, Environmental & Occupational Health; Prevention; Life Sciences & Biomedicine; Middle income
• Research Categories: Health Sciences, Oncology; Health Sciences, Health Care Management; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

India's cervical cancer screening program was launched in 2016. We evaluated baseline facility readiness using nationally representative data from the 2012–13 District Level Household and Facility Survey on 4 tiers of the public health care system - 18,367 sub-health centres (SHCs), 8540 primary health centres (PHCs), 4810 community health centres and 1540 district/sub-divisional hospitals. To evaluate facility readiness we used the Improving Data for Decision Making in Global Cervical Cancer Programmes toolkit on six domains - potential staffing, infrastructure, equipment and supplies, infection prevention, medicines and laboratory testing, and data management. Composite scores were created by summing responses within domains, standardizing scores across domains at each facility level, and averaging across districts/states. Overall, readiness scores were low for cervical cancer screening. At SHCs, the lowest scores were observed in ‘infrastructure’ (0.55) and ‘infection prevention’ (0.44), while PHCs had low ‘potential staffing’ scores (0.50) due to limited manpower to diagnose and treat (cryotherapy) potential cases. Scores were higher for tiers conducting diagnostic work-up and treatment/referral. The highest scores were in ‘potential staffing’ except for PHCs, while the lowest scores were in ‘infection & prevention’ and ‘medicines and laboratory’. Goa and Maharashtra were consistently among the top 5 ranking states for readiness. Substantial heterogeneity in facility readiness for cervical cancer screening spans states and tiers of India's public healthcare system. Infrastructure and staffing are large barriers to screening at PHCs, which are crucial for referral of high-risk patients. Our results suggest focus areas in cervical cancer screening at the district level for policy makers.