Implementing a Community Health Worker Program for Timely Cancer
Diagnosis through Cancer Screening at XYZ Hospital, Aizawl,
Mizoram, India.
EXECUTIVE SUMMARY
The Community Health Worker (CHW) program aims to train and deploy 10 CHWs from
the local community to in response to Aizawl's healthcare challenges regarding delayed
diagnosis of cancer, XYZ Hospital proposes implementing a Community Health Worker
(CHW) program to address the region's high cancer rates and healthcare access
disparities. Aizawl, Mizoram, India, with a population of 415,000, including 100,000
residents in underserved rural areas of which 4,080 cancer cases were recorded in
Aizawl, faces significant socioeconomic barriers and limited medical facilities,
exacerbating the late detection of cancer cases.
Through comprehensive tools such as PESTLE analysis, Fishbone, SWOT and Risk
matrix were used, critical factors influencing healthcare access and delayed cancer
diagnosis have been identified and addressed. The workforce plan emphasizes local
recruitment, training, and ongoing support to enhance community integration and
service delivery effectiveness. A Gantt chart outlines a comprehensive timeline
spanning 12 months, with an estimated budget of £15,300(INR1,663,627.00) sourced
from government.
,INTRODUCTION
In XYZ Hospital, located in Aizawl, Mizoram, India, late cancer detection poses a
significant barrier to community health and well-being (Suresh et al., 2023). With a
population estimated at 415,000 in 2024, including 100,000 residents in rural areas
where 4,080 cancer cases were reported, the region faces a critical cancer crisis
(“Mizoram Population Census 2011, Mizoram Religion, Literacy, Sex Ratio - Census
India”) Cancer rates are notably high, with men at 197.2 per 100,000 and women at
164.9 (Zomawia et al., 2023), leading to Aizawl being labeled as India's cancer hub by
various media outlets (Mizoram Health & Family Welfare Department, 2022). The
healthcare system grapples with challenges such as inadequate medical facilities,
healthcare professional shortages due to migration, limited technology access, low
confidence in telemedicine, and socioeconomic constraints, collectively limiting
healthcare service accessibility (Mizoram Health & Family Welfare Department,
2022).To address these issues, XYZ Hospital proposes implementing a Community
Health Worker (CHW) Program tailored to meet the community's urgent healthcare
needs (Al-Azri, 2016). CHWs will play a crucial role in facilitating cancer screenings,
conducting awareness campaigns, and delivering basic healthcare services, thus
bridging infrastructure gaps and addressing healthcare workforce shortages (Wang,
2022). These frontline workers will act as advocates within the community, enhancing
healthcare utilization and addressing psychosocial needs (Wang, 2022). Using
methodologies like PESTLE analysis (Appendix 1) which is used to evaluate and
monitor the external factors impacting an organization (Battista, 2024). Mizoram faces
political challenges such as inadequate healthcare funding and low prioritization of
cancer screening. Economic factors include low per capita income (Rs. 232,126 or
approximately 2,300 GBP) and high out-of-pocket healthcare expenses (Government of
Mizoram, 2024). Socially, there is limited awareness and cultural stigma surrounding
cancer, while technologically, rural areas lack advanced diagnostic tools and skilled
healthcare professionals (Watanate et al., 2023). Regulatory and environmental factors
further hinder healthcare accessibility. Fishbone analysis which is finding the underlying
,causes of quality problem and it is done with the help of the Fishbone diagram
(Appendix 2), also called the Ishikawa diagram (Juran & A. Blanton Godfrey, 1999). It is
evident that there are several factors contributing to the delayed cancer diagnosis in
Mizoram including limited awareness, cultural stigma, lack of diagnostic tools, inefficient
workflows, inadequate training, geographical challenges, insufficient funding, regulatory
delays (Marajo et al.,2023). Addressing these root causes is essential for improving
early detection and treatment outcomes in the region. The recommended solution,
following a thorough evaluation, is to implement a CHW Program focused on conducting
screenings and raising awareness through methods like visual inspections. This
approach aims to reduce delays in diagnosis and enhance community health
awareness in Aizawl, Mizoram.
IMLEMENTATION PLAN
Aim:
To implement a Community Health Worker (CHW) program in Aizawl, Mizoram aimed at
reducing delayed diagnosis of cancer and improving access to timely screening and
healthcare services in rural areas.
SMART Objectives:
1) To recruit and train 10 CHW’s who have finished their secondary level education
from the community in 3 months.
2) Train CHW’s to screen 10 community members each per day summing 100 per
day and 2500 per month by everyone.
3) To Increase the percentage of rural residents in Aizawl, Mizoram receiving timely
cancer screenings by 40% within one year.
4) Evaluate the CHW program's impact on reducing delayed cancer diagnosis rates
in Aizawl, Mizoram by conducting a comprehensive assessment after one year of
implementation.
, Strategics priorities:
At the local level, the CHW program in Aizawl enhances healthcare access (Wang,
2022), particularly in rural areas, through community health workers (CHWs) facilitating
cancer screenings and health education (National Institute for Health and Care
Research, 2023). This approach fosters community involvement and ownership of
health initiatives. Nationally, it supports India's goals for health equity and universal
health coverage (UHC) (Lehmann et al., 2019), focusing on underserved regions and
preventive healthcare (Kale et al., 2023; Friedman & Moose, 2023). Internationally, the
program contributes to global health equity and sustainable development goals (SDG)
(Kurapati & Thippaiah, 2022), by addressing healthcare disparities and promoting
preventive measures (Kale et al., 2023; South, 2015). It exemplifies a community-
centred approach, emphasizing local engagement to achieve broader global health
objectives and reduce health inequalities.
SWOT ANALYSIS
As per the SWOT analysis for the solution (Appendix 7), the Strengths include a
community-based approach have been vital in enhancing access to care, focus on
preventive healthcare, scalability, sustainability, and enhanced healthcare access.
Furthermore, these efforts have improved access to timely and appropriate cancer care,
reducing disparities in treatment and healthcare outcomes (Erku et al., 2023).
Weaknesses involve potential resistance to change and reluctance to seek medical care
(Shore & Kupferberg, 2014). Opportunities lie in community engagement, expanding
healthcare areas, and overcoming cultural and social barriers (Ahmad & Rezaul, 2024).
The threats comprise of the issue with cultural and social barriers pose significant
challenges. These barriers can hinder effective communication, access to healthcare
services, and the adoption of preventive (The Knowledge Academy, 2023). Additionally,
retaining and motivating community members to actively participate in healthcare
Diagnosis through Cancer Screening at XYZ Hospital, Aizawl,
Mizoram, India.
EXECUTIVE SUMMARY
The Community Health Worker (CHW) program aims to train and deploy 10 CHWs from
the local community to in response to Aizawl's healthcare challenges regarding delayed
diagnosis of cancer, XYZ Hospital proposes implementing a Community Health Worker
(CHW) program to address the region's high cancer rates and healthcare access
disparities. Aizawl, Mizoram, India, with a population of 415,000, including 100,000
residents in underserved rural areas of which 4,080 cancer cases were recorded in
Aizawl, faces significant socioeconomic barriers and limited medical facilities,
exacerbating the late detection of cancer cases.
Through comprehensive tools such as PESTLE analysis, Fishbone, SWOT and Risk
matrix were used, critical factors influencing healthcare access and delayed cancer
diagnosis have been identified and addressed. The workforce plan emphasizes local
recruitment, training, and ongoing support to enhance community integration and
service delivery effectiveness. A Gantt chart outlines a comprehensive timeline
spanning 12 months, with an estimated budget of £15,300(INR1,663,627.00) sourced
from government.
,INTRODUCTION
In XYZ Hospital, located in Aizawl, Mizoram, India, late cancer detection poses a
significant barrier to community health and well-being (Suresh et al., 2023). With a
population estimated at 415,000 in 2024, including 100,000 residents in rural areas
where 4,080 cancer cases were reported, the region faces a critical cancer crisis
(“Mizoram Population Census 2011, Mizoram Religion, Literacy, Sex Ratio - Census
India”) Cancer rates are notably high, with men at 197.2 per 100,000 and women at
164.9 (Zomawia et al., 2023), leading to Aizawl being labeled as India's cancer hub by
various media outlets (Mizoram Health & Family Welfare Department, 2022). The
healthcare system grapples with challenges such as inadequate medical facilities,
healthcare professional shortages due to migration, limited technology access, low
confidence in telemedicine, and socioeconomic constraints, collectively limiting
healthcare service accessibility (Mizoram Health & Family Welfare Department,
2022).To address these issues, XYZ Hospital proposes implementing a Community
Health Worker (CHW) Program tailored to meet the community's urgent healthcare
needs (Al-Azri, 2016). CHWs will play a crucial role in facilitating cancer screenings,
conducting awareness campaigns, and delivering basic healthcare services, thus
bridging infrastructure gaps and addressing healthcare workforce shortages (Wang,
2022). These frontline workers will act as advocates within the community, enhancing
healthcare utilization and addressing psychosocial needs (Wang, 2022). Using
methodologies like PESTLE analysis (Appendix 1) which is used to evaluate and
monitor the external factors impacting an organization (Battista, 2024). Mizoram faces
political challenges such as inadequate healthcare funding and low prioritization of
cancer screening. Economic factors include low per capita income (Rs. 232,126 or
approximately 2,300 GBP) and high out-of-pocket healthcare expenses (Government of
Mizoram, 2024). Socially, there is limited awareness and cultural stigma surrounding
cancer, while technologically, rural areas lack advanced diagnostic tools and skilled
healthcare professionals (Watanate et al., 2023). Regulatory and environmental factors
further hinder healthcare accessibility. Fishbone analysis which is finding the underlying
,causes of quality problem and it is done with the help of the Fishbone diagram
(Appendix 2), also called the Ishikawa diagram (Juran & A. Blanton Godfrey, 1999). It is
evident that there are several factors contributing to the delayed cancer diagnosis in
Mizoram including limited awareness, cultural stigma, lack of diagnostic tools, inefficient
workflows, inadequate training, geographical challenges, insufficient funding, regulatory
delays (Marajo et al.,2023). Addressing these root causes is essential for improving
early detection and treatment outcomes in the region. The recommended solution,
following a thorough evaluation, is to implement a CHW Program focused on conducting
screenings and raising awareness through methods like visual inspections. This
approach aims to reduce delays in diagnosis and enhance community health
awareness in Aizawl, Mizoram.
IMLEMENTATION PLAN
Aim:
To implement a Community Health Worker (CHW) program in Aizawl, Mizoram aimed at
reducing delayed diagnosis of cancer and improving access to timely screening and
healthcare services in rural areas.
SMART Objectives:
1) To recruit and train 10 CHW’s who have finished their secondary level education
from the community in 3 months.
2) Train CHW’s to screen 10 community members each per day summing 100 per
day and 2500 per month by everyone.
3) To Increase the percentage of rural residents in Aizawl, Mizoram receiving timely
cancer screenings by 40% within one year.
4) Evaluate the CHW program's impact on reducing delayed cancer diagnosis rates
in Aizawl, Mizoram by conducting a comprehensive assessment after one year of
implementation.
, Strategics priorities:
At the local level, the CHW program in Aizawl enhances healthcare access (Wang,
2022), particularly in rural areas, through community health workers (CHWs) facilitating
cancer screenings and health education (National Institute for Health and Care
Research, 2023). This approach fosters community involvement and ownership of
health initiatives. Nationally, it supports India's goals for health equity and universal
health coverage (UHC) (Lehmann et al., 2019), focusing on underserved regions and
preventive healthcare (Kale et al., 2023; Friedman & Moose, 2023). Internationally, the
program contributes to global health equity and sustainable development goals (SDG)
(Kurapati & Thippaiah, 2022), by addressing healthcare disparities and promoting
preventive measures (Kale et al., 2023; South, 2015). It exemplifies a community-
centred approach, emphasizing local engagement to achieve broader global health
objectives and reduce health inequalities.
SWOT ANALYSIS
As per the SWOT analysis for the solution (Appendix 7), the Strengths include a
community-based approach have been vital in enhancing access to care, focus on
preventive healthcare, scalability, sustainability, and enhanced healthcare access.
Furthermore, these efforts have improved access to timely and appropriate cancer care,
reducing disparities in treatment and healthcare outcomes (Erku et al., 2023).
Weaknesses involve potential resistance to change and reluctance to seek medical care
(Shore & Kupferberg, 2014). Opportunities lie in community engagement, expanding
healthcare areas, and overcoming cultural and social barriers (Ahmad & Rezaul, 2024).
The threats comprise of the issue with cultural and social barriers pose significant
challenges. These barriers can hinder effective communication, access to healthcare
services, and the adoption of preventive (The Knowledge Academy, 2023). Additionally,
retaining and motivating community members to actively participate in healthcare
