Coverage of a Population-Based Non-Communicable Disease Screening Program Using Lot Quality Assurance Sampling in Rural North India: A Mixed Methods Study

Abstract

Aim: We aimed to estimate the coverage of a population-based Non-communicable Disease (NCD) screening program using lot quality assurance sampling (LQAS) and identify factors affecting its implementation in district Nuh of Haryana, India.

Method: A mixed-methods study was conducted with an initial LQAS coverage survey, followed by in-depth interviews. Thirty lots (villages or towns) were sampled in the district, and 20 people aged ≥ 30 years were randomly sampled from each lot. Participants were asked about receiving services under the program. Weighted coverage estimates, which is the proportion of people who had received screening services, were estimated. Using a decision value of more than nine negative responses out of 20 persons, all 30 lots were classified as good or poor performing. In-depth interviews of healthcare providers of good performing lots and district-level health officials were conducted, and factors affecting program implementation were identified.

Findings: Six hundred participants were interviewed (mean age of 44.8 years, 57.2% women). The proportion of people who reported having undergone screening for diabetes or hypertension was 2.1%, and all lots performed poorly based on decision value. Key factors affecting the program were leadership, prioritization of NCD activities, ensuring human resource and material requirements, regular incentives, qualities of workers, and community engagement.

Conclusion: The screening coverage under the population-based NCD screening program was low in district Nuh, Haryana. This needs to be improved by addressing the identified health system and community-related factors.

Keywords: lqas; monitoring and evaluation; non-communicable diseases; rapid epidemiological assessment methods; screening.

Figure 1. Framework showing the factors which facilitate and limit the implementation of the population-based screening program

HWCs: Health & Wellness Centers, MO: Medical Officer, PBS: Population-Based Screening, NCD: Non-Communicable Diseases, CBAC: Community-Based Assessment Checklist, ASHA: Accredited Social Health Activist, CHO: Community Health Officer, RCH: Reproductive and Child Health, PHC: Primary Health Centre, ANM: Auxiliary Nurse and Midwife