Barriers in implementing cancer prevention programme in North Eastern India: A case study from Meghalaya

Background & objectives India accounts for seven per cent of the global cancer burden, with the highest incidence reported from the northeastern region. To address this burden, the Government of India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010, but this programme was implemented in Meghalaya four years after its launch. This paper aims to examine the implementation facilitators and barriers to cancer prevention in Meghalaya within the NPCDCS framework. Methods A desk review prior to the interviews enabled selection of relevant stakeholders from the health system. In this qualitative study, fifty-six healthcare professionals and frontline health workers from various tiers of the health system were involved through twenty in-depth interviews (IDIs) with healthcare professionals and four focus group discussions (FGD) with the frontline health workers. Data were transcribed in local language and subsequently in English. A hybrid coding strategy was adopted and a codebook was developed in MS Excel (version 16.6). NVivo-12 software was used to organize the data and codes, facilitating the identification and categorisation of emergent themes in alignment with the research question. Results While the programme is intended to provide equal attention to cancer prevention activities, hypertension and diabetes took priority. Barriers included inadequacy in information, education, and communication content on breast and cervical cancers; unavailability of acetic acid for cervical cancer screening; and lack of privacy for cancer screenings. Communication gaps stem from the absence of patient tracking mechanism and programme review meetings at NCD clinics. Training inadequacies affected staff confidence in conducting screenings, while low community awareness compromised the accuracy of data collated for the community-based assessment checklist. Preference for traditional healers further complicated the treatment pathways. Interpretation & conclusions Meghalaya's high cancer incidence underscores the urgency to address these gaps for efficient implementation of the cancer activities within NPCDCS framework.