Task Shifting to Community Health Workers for Home Based Early Detection of Cancers

Background Breast, oral and cervical cancers constitute 32.8% of all cancers in India. The majority of these present at an advanced stage. Lack of trained healthcare providers, organized screening programs, and poor accessibility to diagnosis and treatment are the main barriers to early detection of cancers in India. We implemented organized home-based examinations and triaging program by task shifting to community health workers or Accredited Social Health Activists (ASHAs) to encourage people’s participation and mitigate these barriers. The role of ASHAs as health educators and promoters was extended to provide examinations at people’s homes by task shifting and training them extensively. This manuscript describes the methodology of establishing this program in the difficult hilly terrain in Cachar district of Assam. Methods ASHAs were trained for in theory, hands-on skills for examinations and communication. They were supervised by the trainers during their home visits for examinations. Individuals with abnormal findings were then referred to healthcare centers for further investigations and treatment. Results 199/212 (93.8%) ASHAs participated and screened 46278, 70% of the eligible population at their homes. 95.3% of individuals accepted the screening at home. 77% of the individuals presented to nearby healthcare centers for further examination. 57% of these presented to the tertiary care center. We detected 55 cancers and 202 premalignant conditions through this program. Conclusion Task shifting of cancer early detection to ASHAs is feasible and acceptable to people, and examination of individuals can be done at their homes to increase participation and coverage of screening and early detection programs.