Combating non-communicable diseases in rural Lucknow: Are the skills and knowledge of female health workers adequate?

Arunima Saini, Monika Agarwal


Background: India is facing the surging trend of non-communicable diseases (NCD). Forecasting the burden for NCDs, the Government of India (GOI) initiated a program in 2010 across the country, i.e., National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke. The GOI has envisaged the female health workers (FHW) for the last mile delivery of health services under the programme. Available literature shows that FHWs lack essential knowledge regarding chronic diseases. This study attempts to fill these gaps by studying knowledge and skills regarding NCDs among FHWs in rural Lucknow. Objectives were to explore the knowledge about NCDs among ASHAs and ANMs in rural Lucknow and to assess of skills related to NCD screening among ANMs in rural Lucknow.

Methods: It was a cross-sectional study conducted among FHWs of Lucknow, Uttar Pradesh from June 2019 to August 2019.

Results: Among the FHWs, knowledge about NCDs was found to be higher for those with the age more than 40 years, with the education of higher secondary and above and also amongst those who had received previous training for NCDs.

Conclusions: Majority of the respondents were found to have poor knowledge regarding NCDs. Additionally, older age, training and higher education are found to be associated with good knowledge; there is a need of training of grass root level workers for them to correctly identify the symptoms and risk factors of various NCDs.


Non-communicable diseases, Accredited social health activists, Auxiliary mid wives, NPCDCS, Female health workers

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World Health Organization. Global Health Observatory (GHO): NCD mortality and morbidity. Geneva,WHO. Accessed on 15/06/2020.

World health organization. Global status report on Non communicable Diseases 2014. Geneva, Switzerland: World health organization; 2014.

World Health Organization. The World health report: Today’s Challenges 2003.Geneva: WHO; 2003. Accessed on 15/06/2020.

World Health Organization. Diet, nutrition, and the prevention of chronic disease. In Technical report series 916 Geneva: WHO; 2003. trs/2003/en/. Accessed on 15/06/2020.

Indrayan A. Forecasting vascular disease and associated mortality in India. Burden of Disease in India. National Commission on Macroeconomics and Health. Ministry of Health and Family Welfare, Government of India, New Delhi; 2015.

Arokiasamy P. India’s escalating burden of non-communicable diseases. Lancet. 2018;6(12):1262-3.

Ndou T, van Zyl G, Hlahane S, Goudge A rapid assessment of a community health worker pilot programme to improve the management of hypertension and diabetes in Emfuleni sub-district of Gauteng Province, South Africa. J Glob Health Action. 2013;6:19228.

Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. WHO Global Health Workforce Alliance. Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems. Geneva: 2010.

Government of India. National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS). Accessed on 15/06/2020.

Prinja S, Jeet G, Verma R, Kumar D, Bahuguna P, Kaur M, Kumar Economic analysis of delivering primary health care services through community health workers in 3 North Indian states. R PLoS One. 2014; 9(3):e91781.

Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.Cochrane Database Syst Rev. 2010;(3):CD004015.

Training Module for Medical Officers for Prevention, Control and Population Level Screening of Hypertension, Diabetes and Common Cancer (Oral, Breast & Cervical), 2017, Directorate General of Health Services, Ministry of Health and Family Welfare, GOI, India

Evaluation of ASHA Program, 2011, NHSRC, NRHM.

Srivastava RK ed. Reading material for ASHA. Role in prevention and control of non-communicable diseases (NCDs). nhm, mohfw. Book No. 8; 2009. p1.

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS), Operational Guidelines (Revised: 2013-17). DGHS, MOHFW; 2013. p18-21.

Update on ASHA Programme, NRHM, January 2019. Accessed on 15/06/2020.

Bradley HA, Puoane T Prevention of hypertension and diabetes in an urban setting in South Africa: participatory action research with community health workers. Ethn Dis. 2007;17(1):49-54.

Maher D, Ford N, Unwin N Priorities for developing countries in the global response to non-communicable diseases. Global Health. 2012;8:14.

Khanna D, Khargekar N, Budukh A. Knowledge, attitude and practice about cervical cancer and its screening among community healthcare workers of Varanasi District, Uttar Pradesh, India. Journal of Family Medicine and Primary Care. 2019;8(5):1715-9

Abdel-All, M., Abimbola, S., Praveen, D. What do Accredited Social Health Activists need to provide comprehensive care that incorporates non-communicable diseases? Findings from a qualitative study in Andhra Pradesh, India. Hum Resour Health. 2019:17:73.

Gundmi S, Matpady P, Maiya A, Bhat AK, Upadhya V, Shastry N, et al. ASHA’s training on diabetes mellitus and diabetic foot: a ray of hope in improving care in diabetes at community level. Int Diabetes Federation 2017 Congress. 2015;8:2015.

Chauhan Gopal, Thakur JS. Assessing health workers' capacity for the prevention and control of noncommunicable diseases in Haroli health block of district Una in Himachal Pradesh, India: A mixed methods approach. Int J Non-communicable Diseases 2016;1(1):26-9.

Ansari A, Agarwal M, Singh VK, Kumari N, Deo S. Cervical cancer: perception of peripheral health workers in Lucknow: a cross-sectional study. Int J Commu Med Public Health. 2019; 6(4);1536-44.

Murthy MKS, Thomas PT, Dasgupta M. Potential for a comprehensive stroke education: Assessing knowledge about stroke among community health workers- A qualitative study from Urban Bangalore, Karnataka, India. J Family Med Pri Care. 2019;8(7):2424-8.

Kashyap VH, Shivswamy MS. Assessment of implementation of the national programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke at subcenters of Belagavi taluka: A cross-sectional study. Indian J Health Sci Biomed Res 2019;12:21-7.

Chauhan G, Thakur J S. Assessing health workers' capacity for the prevention and control of noncommunicable diseases in Haroli health block of district Una in Himachal Pradesh, India: A mixed-methods approach. Int J Noncommunicable Diseases. 2016;1(1):26.