Cervical Cancer (CA-CX) Prescreening Training of Primary Health Care provides in Public Health Sector

    Amongst rural population most gynecological problems in women remained hidden, neglected and left untreated out of embarrassment, lack of self-respect & body awareness in them. Socio-cultural barriers inhibit women from expressing these problems. Lack of sensitive and accessible quality public health care was an important reason for the same. Along with this in absence of a regular screening programme most reproductive illnesses progresses to a chronic state. Early diagnosis of illnesses, especially gynecological, is imperative for accessing timely health care. Within the public sector, facilities for diagnosis are limited to tertiary care centers.

    In this scenario it was felt necessary to start village-based women-centered health services working on feminist principles. Understanding this need MASUM started the Sadaphuli Health Programme in August 1993.

    In the year 2003 MASUM began to use the pap-smear technique for prescreening of CA-CX in rural women in Purandar. Pap-smear and VIA are both effective techniques of CA-CX screening. VIA (Visual Inspection with 5% Acetic Acid) is an inexpensive yet effective screening procedure which has been endorsed by the WHO. In 2005 we adopted this new VIA screening method in which +ve/-ve is determined visually at the spot and it requires simple equipment and supplies and no laboratory procedure are needed for it. Trained health workers from MASUM did full preparation before they conducted any health gatherings for detection of CA-CX in the community. A total of 6,841 rural women attended these gatherings and underwent health screening (blood pressure and hemoglobin check and general checkup) followed by primary treatment for common illnesses and referrals. Of these 2695 women opted for internal examination (Speculum and bi-manual examination) along with their cervical screening with VIA test. Of these 1001 women were diagnosed with reproductive health problems.

    Since December 2017 to January 2018 the Sadaphuli team undertook the strengthening of the government’s ongoing cervical screening programme through introducing PHC based screening of women for Cervical–Cancer in Pune district of Maharashtra by introducing VIA method of screening into ongoing NCD programme. VIA is an effective and low cost technique in low resource settings like India. The training includes skill building of ANMs and LHVs to conduct screening programme at Sub-Center and PHC level along with providing health awareness to women regarding women’s health concerns and importance of prescreening.

    The training included three days Ca-Cervix prescreening (with VIA and Pap-Smear) and breast examination training of selected ANMs/LHVs in of 12 Blocks were conducted by MASUM’s health staff in consultation with the department.

    The training was designed for two days but went on longer as per the size of the concerned PHC. One day was theoretical training for all ANMs/LHV/Medical Officers. Second day was practical in hand training. Even ASHA workers were given orientation on sexual and reproductive health rights and issues of women. They were oriented to be able to identify at least primary female health issues, be able to disseminate relevant information and be equipped for first person response and talk to village women and encourage them to come for regular check-up etc. ANMs examined the cervix of ASHA workers while both conducted self-examinations too.

    Total practical training conducted in 12 Blocks was 101 while theoretical trainings were 12. In total 310 people received training. 608 ASHA Workers were given orientation.