Project Proposal September 2012 - pbhealth.gov.in State Proposal.pdf · STATE PROGRAMME FOR...

STATE PROGRAMME FOR PREVENTION AND CONTROL OF CANCER

Project Proposal

September 2012

State Health Systems Resource Centre

National Rural Health Mission

Department of Health & Family Welfare

Government of Punjab

Cancer Awareness & Symptom Based Early Detection State Wide Campaign Project Proposal

State Health Systems Resource Centre, Punjab

CANCER AWARENESS AND SYMPTOM BASED EARLY DETECTION MASS CAMPAIGN

STATE OF PUNJAB

The State of Punjab has been in focus because of increasing rate of cancer. The media, both print

and electronic, have created an impression that Punjab, especially the cotton belt of Malwa

Region of the State has become cancer bowl of the State.

Studies on various aspects of cancer have been conducted by various academic bodies including

Punjab Agricultural University Ludhiana, Post Graduate Institute of Medical Education and

Research (PGIMER) Chandigarh, Department of Health & Family Welfare, Punjab and by many

NGOs.

Despite an increasing trend of cancer in the State, it has not been scientifically established as to

whether the incidence of cancer in Punjab is higher or not, as compared to the rest of the country.

It has, however, been well established that cancer is more common in females, who suffer on

account of very high incidence of breast and cervical cancer.

Chief Minister’s Cancer Relief Fund was established with an initial outlay of just Rs. 20.00 crore

which needs to be raised to the tune of more than two and a half times in the next budget.

ROKO Cancer, an NGO working in the State since 2005-06, has conducted 18,628

mammography’s amongst 1, 20, 248 women and has identified 1,175 suspected cases. For the last

two years State has incurred an annual expenditure of Rs. 30.00 lakhs on this project.

In light of the facts stated above, the State Health Department has planned to carry out a mass

awareness campaign and early detection of cancer based on warning signs and symptoms, by door

to door visits. That means covering the total population of more than 2.77 crore spread over an

area of 50,362 sq. km residing in more than 54 lakh households, 12,603 villages and 217 census

towns. This exercise will help not only in locating and detecting the cancer patients but shall also

help in symptom based early detection of cancer in suspect populace. The data so generated help

detect any regional differences on one hand while on the other it shall also divulge the mortality

due to cancer.

RATIONALE



In order to seek the opinion of the experts and academia on the issues stated above and to

ascertain the technical feasibility of visiting the whole population for awareness and symptom

based early detection of cancer, a State Level Meeting was held with experts from Medical

Colleges in the State of Punjab and that from PGIMER Chandigarh.

All experts were of the opinion that such an exercise was technically feasible and with adequate

training it could be carried out by the Auxiliary Nurse Midwives (ANMs), Multipurpose Health

Workers (MPHWs Male) and Accredited Social Health Activists (ASHAs). In accordance with

the advice tendered by the experts, it was decided that in addition to the standard World Health

Organization (WHO) format of warning signs and risk factors, some more questions on both of

these aspects need to be added so as to cover majority of the cancers and the risk factors, so as to

make the Awareness and Symptom Based Early Detection process broad based.



The State of Punjab is experiencing a rising burden of cancer as one amongst the Non-

Communicable Diseases. Cancer is emerging as one of the major health concerns of the public in

general and the State in particular. The population of State in the age group of 35-65 is falling

prey to this dreaded disease. As such cancer is leading to considerable loss in potentially

productive years of life. Economic and Social cost implications of cancer to the society are

enormous and run into crores of rupees that include direct costs to the families of the persons with

illness and indirect costs to the society, due to reduced productivity.

Clinical services, too, need to be more adequately equipped so as to provide the required level of

care for the disease through Health-Care Delivery System at Primary and at the Secondary level as

well. Recent times have seen an increase in the incidence of cancer all over. Higher incidence of

cancer is primarily attributed to Urbanization, Industrialization, Lifestyle Changes, Population

Growth, Increased Life Span (in turn leading to an increase in the elderly population) and

environmental factors like Pesticides, Insecticides, Chemicals and Heavy Metals etc. In India, the

life expectancy at birth has steadily risen from 32.1 years in 1951 to 64 years in 2006, indicating a

shift in the demographic profile. In the State of Punjab life expectancy at birth was 68.6 years for

Female while for Males it was lower by about two years and stood at 66.4 years during 1992-

1996. It is estimated that life expectancy of the Indian Population will increase to 70 years by

2021–25. This will cause a paradigm shift in the disease pattern from Communicable Diseases to

Non-Communicable Diseases like Cancer, Diabetes and Hypertension.

Around two-thirds of the cancer patients approach and curative facilities at a time when the

disease has already reached an advanced stage. Due to this the survival of cancer patients is

affected adversely.

World

Cancer in all forms is responsible for about 12% of deaths globally. In developed countries cancer

is the second leading cause of death, next only to cardiovascular diseases (accounting for 21% of

deaths). In the developing countries, cancer is the third most common cause of death and accounts

for 9.5% of all deaths.

BACKGROUND OF THE CAMPAIGN

MAGNITUDE OF PROBLEM



(STATISTICS FROM GLOBCON (WHO) -2008)

Each year-

>12.6 million diagnosed >7.5 million die

Worldwide -

Lung Cancer (12.7 %) Breast Cancer (10.9%)

Colorectal Cancer (9.8%)

Deaths from cancer -

Lung (18.2%) Stomach (9.7%) Liver (9.2 %)

Five most common cancers

Incidence of Common Cancers as per World Cancer Report, WHO, IARC, 2003

Rank World More Developed

Countries

Less Developed

Countries

Males

1 Lung Lung Lung

2 Stomach Prostate Stomach

3 Prostate Colon/Rectum Liver

4 Colon/Rectum Stomach Oesophagus

5 Liver Bladder Colon/Rectum

Females

1 Breast Breast Breast

2 Uterine/Cervix Colon/Rectum Uterine/Cervix

3 Colon/Rectum Lung Stomach

4 Lung Stomach Lung

5 Stomach Corpus Uteri Colon/Rectum

MALE FEMALE BOTH

Lung Breast Lung

Prostate Colorectal Breast

Stomach Lung Stomach

Liver Stomach Prostate



India

Cancer prevalence in India is estimated to be around 2.0 to 2.5 million, with over 7-8 lakh new

cases detected every year. More than 70% of the cases report for diagnostic and treatment services

in the advanced stages of the disease, leading to a poor survival and high mortality rate.

New cancer cases per year : 7-8 lacs.

Cancer deaths per year : 4-5 lacs.

Cancer prevalence : 22-24 lacs.

Cancer Incidence:

Among males : 46-122 per 100,000 populations

Among females : 57-135 per 100,000 populations

(ICMR – 1999)

Expectations by 2025:

New cancer cases per year : 12-15 lacs.

Cancer prevalence : 25-30 lacs

3.4 % of all deaths in India are due to cancer

7 -8 lakh new cases are detected annually

2-2.5 million cases are present at any given time

MALES FEMALES

MOUTH/ OROPHARYNX CERVIX

OESOPHAGUS BREAST

STOMACH MOUTH/OROPHARYNX

LOWER RESP. TRACT OESOPHAGUS

Punjab

A survey was conducted by the Department of Health in June 2005 in 4 districts of Muktsar,

Bathinda, Faridkot and Mansa to know the number of cancer patients in these districts. The

number of cancer patients was 453, 711, 164 and 420 respectively with a rate of 54.7, 59.2, 28.0



and 57.4 per lakh population in that order. Another survey had been conducted by the Department

in 2009 in which 7738 cases of cancer were identified. District wise figures are given below:

Cancer Survey by Health Department in Punjab 2009e

S. No. District No. of Cases

1. Amritsar 253

2. Barnala 379

3. Bathinda 942

4. Faridkot 245

5. Fatehgarh sahib 176

6. Ferozepur 473

7. Gurdaspur 559

8. Hoshiarpur 476

9. Jalandhar 377

10. Kapurthala 196

11. Ludhiana 771

12. Mukatsar 668

13. Moga 319

14. Mansa 342

15. Nawanshehar 141

16. Patiala 426

17. Ropar 200

18. Sas nagar 133

19. Sangrur 383

20. Tarn Taran 279

Grand total 7738

253 379

942

245 176

473 559

476 377

196

771 668

319 342

141

426

200 133

383 279

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No. of Cancer Cases as per Cancer Survey 2009, Punjab



There are an estimated 20,000-25,000 cancer cases in Punjab. The cost implications of cancer to

the society are enormous and run into hundreds of crores of rupees that include direct costs to the

families of the people with illness, and indirect costs to the society, due to reduced productivity.

Major risk factors for these cases are, unhealthy diet, physical inactivity, alcohol consumption &

tobacco use, excessive use of insecticides, pesticides fertilizers, heavy metals, which are

modifiable. Majority of cancers can be prevented and treated if diagnosed at an early stage. Health

promotion and prevention of cancer is yet to be adequately addressed in the state health system.

Presently, clinical services, too, are not adequately equipped to provide the required level of care

for the disease in primary and secondary health-care settings and even the tertiary care set up is

not providing the state of the art services in the field of cancer.

Department of Health and Family Welfare, Government of Punjab, with the cooperation of

Department of Medical Education and Research has envisaged to launch the State Wide Door To

Door Campaign of Awareness and Symptom Based Early Detection of Cancer with an aim of

providing health care to the patients

State has already initiated some of the activities for prevention and control of cancer through a

cancer cell at the level of Directorate and financial help to the cancer patients through Mukh

Mantri Cancer Rahat Kosh. Yet the level of awareness amongst the public is very low and there

are many misgivings on this front. Public in general rather than having been given the requisite

awareness on the early warning signs so as to generate willingness to reach the doctor for early

detection, is flooded with the figures of cancer which are 50-100 times exaggerated.

Cancer Awareness Campaign aims at integration of cancer interventions within the NRHM

framework for optimization of scarce resources and provision of seamless services to the patients

as also for ensuring long term sustainability of interventions. The institutionalization of cancer at

district level within the District Health System, sharing administrative and financial structure of

NRHM becomes a crucial programme strategy for cancer control.

The Civil Surgeons at District level will ensure implementation and supervision of the

programme activities related to Cancer awareness, health promotion, symptom based

early diagnosis, treatment and referral.

They shall further facilitate partnership with laboratories and health institutions for

early diagnosis and treatment in the private sector.



Simultaneously, efforts will be made to create a wider knowledge base in the

community for effective prevention, detection, referrals and treatment strategies

through convergence by way of the mass awareness door to door campaign with the

help of ASHAs, ASHA Facilitators, ANMs, supervised and guided by the LHVs,

Health Supervisors, BEEs and the Medical Officers in Rural areas.

In urban areas the task shall be accomplished by the Nursing students and faculty of

the Nursing Institutions supported by the Medical Officers.



The proposed exercise of door to door visits by more than 40,000 field workers is to be

undertaken during the state wide mass awareness campaign the first and unique of its own kind

not only in the country but also in whole of the world, with the following objectives:

1. To carry out a mass awareness campaign about cancer, its warning signs with a focus on the

importance of early diagnosis in treatment of cancer, by home visits.

2. To identify individuals showing the warning signs/symptoms rising suspicion of cancer.

3. To locate and find the Number of existing cases of cancer already diagnosed so as to

identify the needs to strengthen preventive, treatment and palliative care facilities of cancer

in Punjab.

4. Capacity building amongst the Accredited Social Health Activists (ASHAs), ASHA

Facilitators, Auxiliary Nurse Midwives (ANMs), Multipurpose Health Workers

(MPHWs Male), the Nursing Students, Medical and Para Medical manpower.

Quality Assurance: it shall be seen that at the levels whether training, identification, diagnosis

and treatment of the patients shall be to the best of our resources.

AIMS & OBJECTS



The vast exercise is to be undertaken by way of door to door visits by the ASHA, ASHA

Facilitator & MPHW (F&M) in the rural areas and in the urban areas, the same shall be carried

out by the students of Nursing Institutes. The main Goals are:

1. Generation of awareness about cancer amongst the masses.

2. Identification of the existing patients suffering from cancer.

3. Assortments of those cancer cases who have received any financial help from any agency

and those who have been left out.

4. Proportion of the number of cancer patients in the State of Punjab with that in the rest of the

country.

5. Identification of persons depicting the warning signs.

6. Detection of early cases of cancer on the basis of symptoms and their medical examination

and medical aid to them.

7. Diagnose of the cause of the symptoms and medical aid to the patients who don’t turn out to

be the cancer patients.

8. Enhancement of the capacity of the field workers ASHAs, ASHA Facilitators, ANMs,

LHVs, Supervisors, IEC staff and the Medical Staff.

9. Assessment of the regional difference in the occurrence of cancer cases in the three regions

of Punjab i.e. Malwa, Majha and Doaba.

10. Mortality Burden due to cancer in the last five years in the State.

11. Age group wise distribution of cancer cases and assessment of the impact of the disease on

the economy of the state and the future generations and development of linkage as the

campaign with the cancer registry and cancer atlas project Punjab.

12. Assessment of Gender variations in incidence of Cancer.

13. Increased awareness about Mukh Mantri Cancer Rahat Kosh and better utilization of the

Kosh.

GOALS AND EXPECTED OUTCOMES



The idea for carrying out the present activity was generated by the general impression about the

numbers suffering from cancer, the lack of awareness amongst the public in general, the huge

difference in the projected figures given by the academic studies done by various academic bodies

including PGIMER, Chandigarh and the repeated survey by the Directorate of Health and Family

Welfare, Punjab. The first step taken by the department was to involve ASHA in the care of

cancer patients and as such the proposal for incentive to ASHA has been approved by the

Government of India. The next was to assess the view point of the experts about cancer awareness

and its early detection. Whole of the present exercise has been conceptualized and planned after a

meeting of the experts and administrators and the same has been based on their opinion. As such

the state wide awareness campaign by door to door visits is to be carried out.

A core committee comprising of experts from various medical institutes of repute has been

constituted in order to accomplish the following tasks:

To design the proformas

To address the issues concerned with awareness campaign

To prepare the list of warning signs and symptoms

To design the training methodology

Preparation of training schedule

Working out of training curriculum

To formulate the training Pyramid

To chalk out the plan for the awareness campaign

Data capturing, consolidation and analysis

Follow up

METHODOLOGY



1. Awareness Generation regarding the campaign from top to the grass root level.

2. Identification, Planning and Deployment of the Manpower that will carry out the task.

3. Designing the proformas,

4. Enlisting the warning signs of cancer for awareness campaign.

5. Preparation of the syllabus and the training schedule.

6. Capacity Building and Training.

7. Training Components and Training Pyramid

8. Area mapping and Field Worker allocation.

9. Preparation of Area wise and Worker wise display charts of coding.

10. Door to Door Visits, awareness and capturing the data.

11. Data Consolidation and Transfer.

12. Data Tabulation and Analysis

13. Care of the suspected cases and already diagnosed cancer patients.

In order to remove scare the PRIs shall be motivated to take up the awareness generation

through the community radios and through the audio systems available with other sources in

the community.

Informal opinion leaders shall be encouraged and mobilized to help

Cable network shall also be used for creating awareness.

School Students and the Teachers shall be made aware through morning assemblies about

the exercise.

ICDS workers shall be involved to motivate the persons of their area of operation for

participation in the campaign.

MAJOR COMPONENTS OF THE CAMPAIGN

A. AWARENESS GENERATION



The Chowkidars with Revenue Department shall also make announcements in respective

villages.

The RMOS, Ayurvedic MOs and HMOs others shall also generate awareness about the

campaign and its need.

Press Conferences & News in Electronic Media shall also be a part of Awareness

Generation Programme.

Posters/ Hand Bills/ Booklets/ Banners shall be prepared.

The campaign shall be conducted by the ASHA, ASHA Facilitator, ANMs, MPW (M&F) in

the rural areas. In the urban and semi urban areas the same shall be done by the students of

various Nursing Institutions like that of ANM, GNM, B. Sc., and M.Sc. Nursing.

There are 16,800 ASHAs, 900 ASHA Facilitators, 6,200 ANMs /MPW (M&F) already

working in the field of Health Care Delivery System. In addition, more than 1,000 Trained

Dais etc. working with the department are also available. As such, this manpower shall

conduct the campaign in the rural area.

As per Census 2011, Rural Population of Punjab is 1, 73, 16, 800 and by making an

allowance for increase, it is likely to be around 1.76 lakh. Hence, out of the 25,000 field

workers, who shall be trained for carrying out this task in Rural Areas, even if 10% drop

out, we shall have 22,500 trained manpower and each one shall have to enlist 800

individuals comprising about 160 families.

Approximate time to be taken for door to door campaign proper:

In general, it is a task of one week @ 25 families a day.

B. WHO WILL CARRY OUT THE DOOR TO DOOR CAMPAIGN?

RURAL AREA

IDENTIFICATION, PLANNING AND DEPLOYMENT OF THE MANPOWER



However, even if 10 families are visited daily, the whole task can be accomplished over a

period of 16 days.

Taking exigencies into account the work in Rural Areas is likely be over within three

weeks.

Consolidation and data transfer to various levels including State Headquarters is likely to

be completed in about two weeks’ time and by any means the whole exercise of data

capturing and transfer shall take 6 weeks at the most.

Shortage of field workers, if any, in Rural Areas shall be met with by the Nursing

students, who shall cater to the Semi Urban Areas also.

Village-1

Village-2

Village-3 Village-4 Village-5

Village-6

ASHA ASHA ASHA ASHA ASHA ASHA F ANM

Manpower

ANM, ASHA, ASHA Facilitator, MPHWs (Male)

Village-7

SUB CENTRE



There are 217 census towns which are likely to consist of 3,000 municipal wards.

The field workers shall be drawn from the Nursing Schools and Nursing Colleges

numbering about 200 and 90 respectively. Out of these 20,000 Nursing Students shall be

drawn from senior classes for visiting the urban population which is likely to be

1, 04, 00, 000 by now. Each field worker shall have to visit a population of 600-700 and as

such 120 to 140 families.

In the urban areas @ 20 families per day the whole exercise shall take one week.

If 10 families are visited daily the exercise shall be over within a period of two weeks.

Adding the grace period for other unforeseen exigencies the task of carrying out the

awareness campaign by door to door visits shall be over in three weeks.

By the same logic as for the rural areas, the data consolidation and transfer time, when

included, the accomplishment of the task in urban areas shall also be co-terminus with

that in the rural areas

The population being concentrated the exercise shall be easier in the urban areas and

can be finished in lesser time.

Towns

Pop Slot-1

Pop Slot-2

Pop Slot-3 Pop Slot-4

Pop Slot-5

Pop Slot-6

Nursing

Student

Nursing

Student

Nursing

Student

Nursing

Student

Nursing

Student

Nursing

Student

s Manpower

Nursing Students, Faculty of Nursing Institutes, ANM

URBAN AREA



Proforma No. 1 (P-1) shall be consolidated in Consolidation Proforma No. -1 (CP-1) by the

field workers

The compiled data of the field workers shall be compiled by the supervisors in

Consolidation Proforma No.-2 (CP-2)

The Data from Consolidation Proforma No.-2 (CP-2) provided by the supervisors shall be

compiled by the CHC in rural areas and the nursing institute in urban areas in Consolidation

Proforma No.-3 (CP-3)

The data of Consolidation Proforma No.-3 (CP-3) shall be compiled in Consolidation

Proforma No.-4 (CP-4) at the district level in Civil Surgeon’s office. DPM and MEIO shall

perform the task

The data of all the 22 Consolidation Proforma No.-4 (CP-4) shall be compiled in

Consolidation Proforma No.-5 (CP-5) at state headquarter.

Consolidation of Data

Proformas Rural Area Urban Area Level

Consolidated Proforma 1 ANM Nursing Students Field Level

Consolidated Proforma 2 LHV/Supervisor Supervisor Sector Level

Consolidated Proforma 3 BEE Institutions Block Level

Consolidated Proforma 4 MEIO District Level

Consolidated Proforma 5 State HQ State Level

Field

Level

to

State

Level

Data

Consoli

dation

C. DATA CONSOLIDATION AND TRANSFER



This shall have about 25 indicators and various options are available for the same

1. Manual entry at the CHC /Nursing Institute and transfer of data.

2. Data collection on OMR Sheet and scanning.

3. Computer friendly sheet and data scanning

4. Mobile application

D. DATA CONSOLIDATION AND TRANSFER OF DATA FROM FIELD PROFORMA No. 2



All of them shall be taken care by the ASHA, ASHA Facilitator and the ANM concerned in

the Rural as well as Urban Areas.

RURAL AREA

Village ASHA,

ASHA Facilitator

ANM

Primary Health

Centre

Community

Health

Centre/Sub

Divisional

Hospitals

District

Hospital

Medical

Colleges

E. MEDICAL CARE TO THE ONES WHO ARE IDENTIFIED AS SUSPECTS OR AS THE

DIAGNOSED CASES, DURING THE CAMPAIGN



URBAN AREA

WARD

ANM

Civil Hospital/

Civil Dispensaries

Sub Divisional

Hospitals

District

Hospital

First Referral

Second Referral

Third Referral

Medical

Colleges



FIRST REFERRAL LEVEL

After the campaign, it is likely that nearly 2.5-3 lakh persons shall be coming up in the category of

suspected cases. They shall be referred to the First Referral Unit i.e. to the concerned PHC in the

Rural Areas in which their residence falls and urban ones to the urban Dispensaries /Civil

Hospitals falling in concerned urban areas.

The days for the cases of each field worker shall be fixed, so that on a particular day only 10

cases from the campaign are taken to the PHC / Civil/ Urban Dispensary/Civil Hospital

The Medical Officer there shall filter out the cases as cancer suspects and others after

carrying out a detailed medical examination on the basis of the check list provided to them.

Previously diagnosed cancer patients shall be made aware about the services which they

shall be able to avail at the PHC and further in the Pyramid at higher levels for cancer.

Cancer patients who have not availed the Mukh Mantri Cancer Rahat Kosh shall be guided

and helped for the same.

The patients shall also be made aware about the drugs made available at very low rates

through Government efforts.

The patients shall be made aware about the Government facilities and those of the

empanelled hospitals etc. for diagnosis and treatment of cancer.

The persons who are still suspects shall be referred to the CHC/Sub Divisional Hospital in

the rural and the urban areas respectively.

The referral shall be planned so that not more than 10 patients are sent to a CHC on a given

working day and not beyond 10-15 patients to any of the SDHs on any working day.

The patients who have some symptom but are not diagnosed as cancer patients shall be

provided medical care/ advice for their problem.



SECOND REFERRAL LEVEL

As already detailed above all the cases short listed by FRUs shall be sent to the CHC in rural

Areas and SDH in urban areas.

The cases referred by the first level shall be thoroughly examined by the specialists

available there and the available investigations shall also be done as per requirement and

feasibility.

The Diagnosed cases shall be put in the line of management at the appropriate level.

The cases that are still suspect shall be referred to District Hospitals in a planned manner so

as to ensure hassle free care to the patient and also not to over stretch the facilities available.

Not more than 20 patients shall be referred to a District Hospital on any working day.

All cases after filtration shall be sent to the District level Hospitals from where they shall be

referred for confirmatory tests at the tertiary level i.e. the State Medical Colleges. The

referral to Medical Colleges would be in accordance with their area of jurisdiction for

Medical Boards, already duly notified as the same as under.

THIRD REFERRAL TO THE TERTIARY CARE INSTITUTES

o Cancer clinics shall be established in the Tertiary Care Institutes.

o All specialists shall be available in the clinic.

o Patient shall not have to run around

o Not more than 20 patients shall be referred to any Tertiary Care Institute on any given day.



The patients who are put into the category of suspect due to some symptoms shall also be treated

by the first/ 2nd

level hospitals.

(i) Since ASHAs shall be accompanying the suspects and the cancer patients, they shall have not

to run around.

(ii) Treatment and Diagnostic facilities available at Government institutions shall be free, so that

there is no requirement for the arrangement of finances.

(iii) Only 10 patients shall be referred on a given day so no long waiting because of any over

burden

(iv) Since day for visit is to be predetermined there would be no uncertainty.

(v) Trip to hospital can be well planned in advance.

CARE OF THE CASES WHO ARE SUSPECTS AT CAMPAIGN OR FIRST LEVEL BUT ARE NOT

CANCER CASES

HASSLE FREE CARE



Administrators / Supervisors and field workers

DURATION: - One Day at Each Level.

The training Pyramid shall consist of as under

1. State Key Resource Persons (KRPs): They shall be the members of Core Team, SHSRC

team and that of the SIHFW.

2. State Level Resource Persons (SRPs): They shall be the District Officers including Civil

Surgeons/ DFWO/ DHO/ MOH and the Epidemiologists.

3. They shall be trained by the State KRPs at the State Institute of Health and Family Welfare in

three workshops of one day each consisting of 25-30 trainees in each workshops.

4. District Resource Persons (DRPs): The SMOs, District Programme Officers, MEIOs,

Deputy MEIOs. numbering around 440 shall be trained by the respective SRPs at the

respective District Head Quarters for one day each. The training shall be supervised and

monitored by the KRPs.

5. Block Resource Persons (BRPs): Shall include MOs, BEEs, LHVs and Supervisors M&F,

numbering about 4000 to be trained at CHC/SDH by holding a one day training workshops.

160 workshops of 25 trainees each shall be conducted by the DRPs and the same shall be

supervised by the SRPs.

6. Field Workers:

RURAL: ASHAs, ANMs, MPW (M&F), about 25,000 in number and shall be trained by the

BRPs in the workshops numbering about 575 to be held at Mini PHCs/ RHs/ CHCs. Training

to be imparted by BRPs under Supervision of the DRPs.

URBAN: Nursing Students of GNM/ B.Sc. Nursing, 20,000 in number to be trained in 400-

500 workshops to be held at the respective Institutes. BRPs from their own institutes shall

train them who in turn shall be trained by the DRPs.

7. The DRPs shall be the Faculty of institutes to be trained in District workshops by the SRPs.

TRAINING PYRAMID



RURAL AREA

State Key Resource Persons (KRP)

State Level Resource Person (SRP) District Officers

District Resource Persons (DRP) District POs & SMOs

Block Resource Persons (BRP) MOs, BEEs, LHVetc.

Field Workers ANM, ASHA, AF, MPW

KRP

State Resource Person (SRP)

District Officers- 4 Each District

District Resource Person (DRP)

SMOs and District Officer- 20-25 per district

Block Resource Person (BRP)

MOs, BEEs, LHVs, Supervisors- 20-25 per block

Field Workers

ANM, ASHA, ASHA Facilitator, MPWs



URBAN AREA

State Key Resource Persons (KRP)

State Level Resource Person (SRP) District Officers/Principals

District Resource Persons (DRP) Coord./Faculty Mem.

Block Resource Persons (BRP) Faculty Members

Field Workers Nursing Students

KRP


District Officer-Principals


Coordinator, Faculty Members


Faculty Members

Field Workers

Nursing Students



Training/ Workshop- Days

Data shall be compiled, consolidated and segregated in accordance with the area of operation of

the Concerned Medical Colleges. Final report shall be prepared with help of PGIMER/ SHSRC/

SIHFW/ other experts as per needs for further action.

It has been planned that the finalized proforma and the training schedule as well as syllabus

shall be placed at the disposal of the SIHFW.

The State Institute of Health & Family Welfare shall conduct training of the State Resource

Persons (SRPs).

The SRPs in turn shall carry out training of the District Resource Persons (DRPs) in the

district workshops.

The DRPs shall conduct the Training of the Block Resource Persons (BRPs).

Block Resource Persons (BRPs) in turn shall conduct training of the Field Workers. The

Faculty of Nursing Institutes shall carry out training of the Nursing students

KRP




Field Workers

One Training/Workshop at SIHFW

2-3 Training/Workshops, at SIHFW,

Mohali

20-22 Training/Workshops at

DHQ for RA & 10 for UA

160 Workshops at

CHCs/DH/SDH for RA &

200 at Institutes for UA,

700- 800 Workshops at

Sub Block level for RA and

400-500 at Institute for

UA

LOGISTICS



.

Training for technical aspects like FNAC etc. shall be carried out by the Medical Colleges

for the concerned doctors.

Each speciality shall impart training for the Specialists.

Common lectures and specialty wise hands on training

Ten specialists per specialty per college. Thus 500 specialists shall be trained in 15

workshops of two days’ duration each (5 workshops at each Medical College )

It shall be seen that from each hospital only one/ two shall attend at a time so as to ensure

that each specialist of Surgery, Gynaecology, Medicine, Radiology and Pathology is covered

in a period of two weeks.

The Proformas and Awareness Material/ Training Material shall be prepared by the Core

Committee and the same shall be published by the NRHM.

The existing Infrastructure and Manpower shall be used but ASHA shall be provided incentive for

the cancer cases which are either detected on basis of symptoms or are already diagnosed ones

that she brings for treatment and follow up.

Depending upon the design of the Proforma, if, it is to be scanned like OMR sheet, the same shall

be outsourced through BFUHS or if the data is to be entered then the Data Entry Operators/

Statistical Assistants along with computers shall accomplish the task. If mobile application as that

of HMIS is used, then ANM/ Faculty of nursing institutes shall transfer the data.

The Block Level Manpower shall be consolidating the Proforma No.2 at CHC and there

shall be about 1,500 Proformas per CHC.

TRAINING OF SPECIALISTS

PROFORMAS AND MATERIALS

INFRASTRUCTURE



For urban areas the data of Proforma No.2 shall be entered and consolidated at the level of

concerned Nursing Institutes and for each institute there is likelihood of 500 proformas.

The Family data of Proforma No.1 (P-1) shall be consolidated at various levels. Each field

worker shall consolidate his own data of 500-800 population in the Consolidation Proforma-

1 (CP-1).

The supervisors shall consolidate the data of consolidation proformas of their field workers

in Consolidated Proforma-2 (CP-2).

The Block/ Nursing Institute team shall consolidate the data of Consolidation Proforma

(CP-2) in Consolidated Proforma-3 (CP-3).

District Team of Programme Officer, MEIO, Dy. MEIO, District Programme Manager shall

compile the data from Consolidation Proforma No-3 (CP-3) sent by the CHCs and the

Nursing Institutes in Consolidation Proforma No.-4 (CP-4).

State Headquarters shall consolidate the data of Consolidated Proforma-4 (CP-4) in

Consolidated Proforma-5 (CP-5).



State wide Campaign Training/ Materials of one day training of the supervisors at various levels

and the field workers, for door to door visiting for Cancer Detection and Symptom Based Early

Detection.

TOT for Cancer Campaign – State level Key Resource Persons

Training Load = 20

Duration of training = 1 days

Participants / Batch = 20

Total Batches = 1 batch

Honorarium @500*4*1 = 2,000/-

Contingency @300*1*20 = 6,000/-

DA to participants @300*1*20 = 6,000/-

TA to Participants @1000*20 = 20,000/-

Training/ Campaign Material Required @500*20 = 10,000/-

Cost of One Batch = 34,000/-

TOT for Cancer Campaign – State Level( SRPs) Officers

Training Load = 80




Honorarium @ 500*4 = 2,000/-

Contingency @400*1*45 = 18,000/-

Working lunch etc. @200*1*45 = 9,000/-

Training/Campaign Material Required @500*45 = 25,000/-


Cost of Two Batches @54,000*2 = 1,08,000/-

TOT for Cancer Campaign – District Level Officer & SMOs, MEIOs & Dy. MEIOs (DRPs)

Training Load = 440




Honorarium @500*4*1 = 2000/-

Contingency @300*20 = 6,000/-

DA to participants @300*20 = 6,000/-


Training /Campaign Material Required @500*20 = 10,000/-


Cost of 22 batches @44,000*22 = 9,68,000/-

FINANCIAL INPUTS/ IMPLICATIONS



TOT for TOT for Cancer Campaign – MOs, BEEs, LHVs, Supervisors M& F (BRPs)

Training Load = 4000



Total Batches = 160 batches

Contingency @300*1*25 = 7,500/-

DA to participants @300*1*25 = 7,500/-


Training /Campaign Material Required @200*25 = 5,000/-


Cost of 160 Batches @27500*160 = 44,00,000/-

TOT for Cancer Campaign – Field workers ASHA, ANMs/ MPW M&F( Rural)

Training Load = 25,875

Total Batches = 575

No of Trainees per Batch = 45

Duration = 1Day

Contingency @100*45*1 = 4,500/-

(Amount per participant*No of participants*Duration)

{A}TA (as per state Govt. Rule) @50*45 = 2,250/-

Training/Campaign Material @100*45 = 4500/-

Cost of the Batch = 11,500/-

Cost of 575 Batches @11500*575 = 66,12,000/-

TOT for Cancer Campaign – Nursing Students GNM & B.Sc.( Urban /Semi-Urban areas)

Training Load = 16,000

Total Batches = 400

No of Trainees per Batch = 40

Duration = 1 Days

Training/campaign Material @120*40 = 4800/-

Contingency per batch = 1200/-

Cost of the Batch = 6,000/-

Cost of 400 Batches @6000*400 = 24,00,000/-



Cost of One Batch of State Level Officers ( KRPs) = 34,000/-

Cost of 2 batches of District Level Officers ( SRPs) = 1,08,000/-

Cost of 20 Batches of SMOs, MEIOs, Dy. MEIOs ( DRPs) = 9,68,000/-

Cost of 160 Batches of MOs, BEEs, LHVs & Supervisors = 44,00,000/-

Cost of 575 Batches of MPW ( F &M )/ANMs & ASHA = 66,12,000/-

Total Cost for Training of N. Students BSc. & GNM = 24,00,000/-

GRAND TOTAL = 1,35,22,000/-

TOTAL COST FOR TRAINING FOR CANCER CAMPAIGN = 1, 35, 22,000/-

Materials and other costs = 65, 00,000

Total = 2, 00, 00,000

This exercise being a campaign the appropriation with in the subheads may be done subject to

overall limit.



Each activity shall be monitored and evaluated at each step so as to make the necessary

corrections.

External monitoring shall be encouraged.

The proformas and schedule/ syllabus shall be ready by 31 -07-2012

Subject to availability of funds proformas and training materials should be ready by 15 -09-

2012

The training at all levels would be completed by 30-11-2012

Awareness campaign and data collection by 31-12 -2012

Data consolidation and analysis by 31-03-2013

TIME FRAME

MONITORING & EVALUATION



Activity Time Frame

Preliminary Consultations April 2012

Expert Consultations May 2012

Formal Detailed Project Foundation May/ June 2012

Getting Tentative Provisions of Budget May 2012

Finalization of Proformas June 2012

Finalization of Data Transfer Mechanism July 2012

Pre-Test July-August 2012

Finalization of Training Curriculum July 2012

Finalization of Training Schedule July 2012

Issuance of Government Orders in Specific Reference to

the Campaign

August 2012

Area Mapping August 2012

Manpower Mapping August 2012

Coding September 2012

Training Material and Proformas and Other Materials October/ November 2012

Completion of Training at all Levels 30th

November 2012

Awareness Campaign and Symptom Based Identification 31st December 2012

Data Consolidation, Transfer and Analysis 31st March 2013

Submission of Report 15th

May 2013

Finalization of Accounts and Submission of UC 31st May 2013

Completion of Clinical Examination and Medical Aid to

all

31st August 2013

ACTION PLAN



CANCER CONTROL, PREVENTION AND TREATMENT

CANCER AWARENESS

AND

SYMPTOM BASED EARLY DETECTION STATE WIDE DOOR

TO DOOR CAMPAIGN

DEPARTMENT OF HEALTH IS AT YOUR DOOR STEP

AVAIL MUKH MANTRI CANCER RAHAT KOSH

CONTACT: ASHA/ ANM IN YOUR AREA

STATE HEALTH SYSTEMS RESOURCE CENTRE

NATIONAL RURAL HEALTH MISSION

DEPARTMENT OF HEALTH & FAMILY WELFARE

GOVERNMENT OF PUNJAB



List of the Administrators and the Experts who have contributed in the finalization of the idea of

Cancer Awareness and Symptom Based Early Detection, State Wide Door to Door Campaign.

S.No Name Designation

1 Smt.Vini Mahajan Principal Secretary, Government of Punjab, Department of

Health & Family Welfare

2 Smt.Anjali Bhawra Secretary, Government of Punjab, Department of Medical

Education & Research

3 Smt. Seema Jain Director, Census Operations, Punjab

4 Sh. Raj Kamal

Chaudhari

Secretary, Government of Punjab, Department of Health &

Family Welfare

5 Smt. Raji P.

Srivastava

Managing Director, Punjab Health Systems Corporation

6 Sh. S.K.Sharma Mission Director, National Rural Health Mission, Punjab

7 Smt. Rupanjli Karthik Additional Secretary, Department of Health & Family Welfare,

Punjab

8 Dr. J.P.Singh Director Health Services, Punjab

9 Dr. P.L.Garg Executive Director, State Health Systems Resource Centre,

Punjab

10 Dr. A.S.Thind Director Research and Medical Education Punjab

11 Dr. Ashok Nayyar Director, Health Services (SI), Punjab

12 Dr. Karanjit Singh Director, Health Services (FW), Punjab

13 Dr. S.C.Sharma Professor & HOD, Radiotherapy, PGIMER Chandigarh

14 Dr. Gurpreet Singh Professor, Surgery, PGIMER Chandigarh

15 Dr. J.S.Thakur Associate Professor, School Of Public Health, PGIMER,

Chandigarh

16 Dr. Manjeet Singh

Bal

Professor & HOD, Pathology, Government Medical College,

Patiala and Principal Investigator, Population based Cancer

Registry

17 Dr. Jatinder Kaur Principal, State Institute of Health & Family Welfare, Punjab

18 Dr. Gurdit Singh Civil Surgeon, Faridkot

19 Dr. Kulwant Rai Professor, Surgery, Government Medical College, Amritsar

20 Dr. Harish Arora Professor, SGGS Medical College, Faridkot

21 Dr. Harjot Bagga HOD Radiotherapy Department, Government Medical College,

Patiala

22 Dr. Kamaljit Kaur HOD Radiotherapy Department, Government Medical College,

Amritsar

23 Dr. Hanuman Yadav HOD Radiotherapy Department, SGGS Medical College,

Faridkot

24 Dr. Paramjeet Kaur HOD Community Medicine, Government Medical College,

Patiala

25 Dr. Pankaj Malhotra Department of Medicine, PGIMER, Chandigarh

26 Dr. Sonu Goel Assistant Professor, School of Public Health, PGIMER,

Chandigarh

27 Dr. B.P.Gupta HOD Community Medicine, Gian Sagar Institutte of Medical

CONTRIBUTORS- ADMINISTRATORS AND EXPERTS



Sciences, Banaur

28 Dr. R.K.Saman HOD Community Medicine, Punjab Institute of Medical

Sciences, Jalandhar

29 Dr. M.K.Mahajan HOD Radiotherapy Department, Christian Medical College,

Ludhiana

30 Dr. Parveen HOD Radiotherapy Department, Mohan Dai Oswal Cancer

Hospital, Ludhiana

31 Dr. Sanjay Gupta HOD Community Medicine, SGGS Medical College, Faridkot

32 Dr. V.K.Dangwal Associate Professor, Department of Radiotherapy, Government

Medical College, Patiala

33 Dr. Anita Juneja Associate Professor, Government Medical College, Amritsar

34 Dr. Rajeev Devgan HOD Radiotherapy Department, Government Medical College,

Amritsar

35 Dr. Sanjeev Mahajan Assistant Professor, Community Medicine, Government

Medical College, Amritsar

36 Dr. Vandhana HOD Radiotherapy Department, Adesh Charitable Cancer

Institute, Shri Muktsar Sahib

37 Dr. Amrit Kaur Tur HOD Radiotherapy Department, Shri Guru Ramdass Rotary

Cancer Hospital, Amritsar

38 Dr. Rakesh Gupta Assistant Director, Cancer Control Cell, DHS, Punjab

39 Dr. Ashok Salwan Associate Professor, Government Medical College, Amritsar

40 Dr. T.Sikri Professor Medicine, Government Medical College, Amritsar

41 Dr. Harpal Singh Associate Professor, Pathology, Government Medical College,

Amritsar

42 Dr. Vijay Kumar Associate Professor, Pathology, Government Medical College,

Patiala

43 Dr. Sanjay Sethi Associate Professor, Radio Diagnosis, Government Medical

College, Patiala

44 Dr. P.K.Bandal Assistant Professor, Surgery, Government Medical College,

Patiala

45 Dr. Ruby Bhatia Assistant Professor, Gynae, Government Medical College,

Patiala

46 Dr. Raja Paramjit

Singh Banipal

Associate Professor, Radiotherapy, GGS Medical College,

Faridkot

47 Dr. Upinder Sharma Assistant Professor, Pathology, SGGS, Faridkot

48 Dr. Parwinder Singh Associate Professor, Gastro surgery , SGGS, Faridkot

49 Dr. Divya Soin Assistant Professor, Medicine, SGGS, Faridkot

50 Dr. Sanjeev Sethi DIO, Faridkot

51 Dr. Anupam Deep Medical Officer, Radio Diagnosis, SGGS Faridkot

52 Dr. Deepinder Singh Assistant Programme Officer, Cancer Control Cell, DHS, Punjab

53 Sh. Satinderpal Singh

Chahal

Consultant HMIS, State Health Systems Resource Centre,

Punjab

54 Dr. Monica Pathak Consultant Community Participation, SHSRC, Punjab

55 Smt. Jaspreet Kaur Documentation Officer, SHSRC, Punjab

56 Sh. Navdeep Gautam Consultant IEC/BCC, SHSRC, Punjab

57 Sh. Davinder Bains Programme Officer, BFUHS

58 Dr. Seema Aggarwal State Epidemiologist, IDSP, Punjab

59 Mr. Jatinder Sharma Finance cum Logistic Officer, NPCDCS Punjab

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