Challenges and coverage of community based assessment checklist (CBAC) for screening of non-communicable diseases by accredited social health activists: a mixed-method study from India

Non-communicable diseases (NCDs) are responsible for 74% of global deaths annually, with significant issues including cardiovascular diseases, diabetes, stroke, and cancer. In India, the prevalence of hypertension is 74.7%, but only 12% have it under control. Known as the diabetes capital of the world, India has 77 million individuals affected by diabetes, with 57% undiagnosed. Cancer screening remains low despite its potential to reduce mortality. In response, the Indian government launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS) in 2010, utilizing the Community-Based Assessment Checklist (CBAC) for ASHAs to screen for NCDs. This mixed-methods study was carried out in a central district of Gujarat. Quantitative data were collected from 400 CBAC forms, while qualitative data were gathered through in-depth interviews with 10 ASHAs. The quantitative data were analyzed using records from the NCD portal, and qualitative data were examined thematically. ASHAs achieved 95% coverage of CBAC forms among the target population. Of those referred with a CBAC score greater than 4, 23% sought further medical attention at primary health centers (PHCs), and 21% were diagnosed with NCDs. Qualitative findings highlighted challenges such as workload, social stigma, and issues with the NCD portal. The study underscores the essential role of ASHAs in the early detection and management of NCDs while identifying the challenges they encounter. Recommendations include ongoing training, simplified CBAC forms, and localized content to enhance ASHA efficiency and improve community health outcomes.