The role of frontline community health workers in the non-communicable disease screening program in Assam, India: Current trends, challenges and scope - A time and motion study

Background: Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) are community workers who play a critical role in awareness, mobilization, screening and referral under the National Cancer Prevention and Control Programme in India. The aim of this study was to assess the time utilisation and factors affecting the work of community workers in Assam, to understand how the cancer control programme could be better integrated into their existing work pattern. Methods: An observational cross-sectional study was conducted with ASHAs and ANMs and their supervisors across two districts of Assam (Jorhat and Dhubri) in September 2018. This included a) Time and motion study with ASHAs and ANMs to capture time spent to accomplish respective tasks. b) Structured interviews with ASHAs, ANMs and their supervisors to understand perceptions of supervisors about the role ANMs and ASHAs play in cancer-related activities. Results: On any working day, the ANMs spent an average of 255 min (4 h 15 min) and ASHAs 246 min (4 h 6 min) on the job including travel time. Maternal and child health received greatest priority with ANMs on average spending 11 min and ASHAs 28 min to address these issues. Both ANMs and ASHAs spent only a few minutes on average to discuss cancer awareness and screening. Proper training, supervision and support for transport for them were among several factors highlighted by ASHAs and ANMs for improvement to make their role more effective in NCDs. Conclusion: Policymakers should re-evaluate the required workforce and workload of community health workers with the goal of improving cancer outcomes.