About this item:

35 Views | 31 Downloads

Author Notes:

Corresponding author: msaraiya@cdc.gov, yzs2@cdc.gov (M. Saraiya).

Author contributions:

Preet K. Dhillon: Conceptualization, Methodology, Supervision, Writing - original draft, Writing - review & editing.

Benjamin D. Hallowell: Conceptualization, Methodology, Software, Formal analysis, Data curation, Writing - original draft, Writing - review & editing.

Sutapa Agrawal: Conceptualization, Methodology, Writing - original draft, Writing - review & editing.

Arpita Ghosh: Methodology, Data curation, Writing - original draft, Writing - review & editing.

Awdhesh Yadav: Conceptualization, Methodology, Software, Writing - original draft.

Elizabeth Van Dyne: Conceptualization, Writing - review & editing.

Virginia Senkomago: Conceptualization, Writing - original draft, Writing - review & editing.

Shivani A. Patel: Conceptualization, Methodology, Writing - original draft, Writing - review & editing.

Deepika Saraf: Methodology, Writing - original draft, Writing - review & editing.

Roopa Hariprasad: Methodology, Writing - review & editing.

Neha Dumka: Methodology, Writing - original draft, Writing - review & editing.

Ravi Mehrotra: Methodology, Supervision, Writing - review & editing.

Mona Saraiya: Conceptualization, Methodology, Supervision, Writing - original draft, Writing - review & editing.

Declaration of competing interest: The authors have no conflicts of interest to disclose.

Disclaimer: the findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Subjects:

Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Medicine, General & Internal
  • General & Internal Medicine
  • Cervical Cancer
  • India
  • Screening
  • Prevention
  • Middle income
  • None

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)

Show all authors Show less authors

Tools:

Journal Title:

Preventive Medicine

Volume:

Volume 138

Publisher:

, Pages 106147-106147

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2020 Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Export to EndNote