Project Report_CInI_V3 PDF

GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) “Improving primary and prevent...

GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) “Improving primary and preventive care for NCD in Jharkhand w.s.r.t. Cancer and Menstrual Hygiene Management” Report Submitted by Prepared for Department of Hospital & Healthcare Collectives for Integrated Livelihood Management Initiatives (CINI) Global Business School & Research Centre 231/B Ashok Nagar Ranchi, Jharkhand Dr D Y Patil Vidyapeeth (Deemed to be University), Pune GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE 1  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Acknowledgement The burden of Non- Communicable Diseases (NCDs) is on rise and the uncontrolled NCD may derail the developments expected from the demographic dividend in terms of significant proportion of people in the productive age group. The increase in the women’s work participation is a great indication for a new trajectory in the development. However the huge unmet need of services in the areas of Menstrual Hygiene, Breast cancer and cervical cancer may negatively affect the work participation rate among women. The modalities of health care service delivery have been changing drastically and innovations are frequently warranted to bring efficiency with higher levels of service delivery and patient satisfaction. The Global Business School and Research Centre (GBSRC) has been bringing a new thrust to the healthcare delivery models through academic research. Apart from the high impact initiatives in the livelihood management, Collectives for Integrated Livelihood Initiatives (CInI) has been working in the areas of NCD and cancer in Jharkhand to improve the preventive and primary aspects. This programme has a high potential to make a breakthrough in creating better awareness and access to health services for the citizens and especially women in the state of Jharkhand. We are highly grateful to CInI for assigning GBSRC the task of basic understanding the demand and supply side analysis of services pertaining to primary and preventive aspects of NCDs, menstrual hygiene, cervical cancer, and breast cancer in Jharkhand. We are thankful to CInI for the support and guidance during the study. During the study, we reached out to more than 210 households in 4 districts of Jharkhand with 4 different study instruments to understand the service delivery from the citizen’s perspective. We have received an overwhelming response from those respondents in terms of their perception and overall experience in the management of basic NCDs and Cancer. Since the CinI programme was also launched in last one year, a special controlled reference was given to the programme to understand the impact of the programme. We wholeheartedly express our gratitude to all the respondents who provided valuable information to help us evaluate the programme in a better way. We have studied various public health policies like NPCDCS, NCCP, DCCP and other government 2  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) documents to gather more information from the supply side and the process of delivery of the services. We are confident that this report would provide information and insights in the right perspective to the stakeholders of the CinI and government of Jharkhand to scale up or replicate the programme in other geographies with appropriate localization. Dr Biranchi Jena Principal Investigator 3  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Project Team Dr Chetan Chaudhari Advisor Dr Biranchi Jena Principal Investigator Dr Shital Naikwade Co-Investigator Prof. Komal Singh Research Officer Ms. Sakshi Awale Project Assistant Ms. Harshal Narule Project Assistant Ms. Upasana Jagtap Project Assistant Ms. Shreel Pathak Project Assistant Mr. Zaidul Haque Project Assistant 4  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) List of Acronyms and Abbreviations NCD: Non-Communicable Diseases MHM: Menstrual Hygiene Management BC: Breast Cancer CC: Cervical Cancer NPCDCS: National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke NCCP: National Cancer Control Programme DCCP: District Cancer Control Programme SC: Sub Centre PHC: Primary Health Center CHC: Community Health Center DH: District Hospitals ANM: Auxiliary Nurse Midwife ASHA: Accredited Social Health Activist HWC: Health and Wellness Centers NFHS: National Family Health Survey RMP: Registered Medical Practitioner NGO: Non-Government Organisation IPHS: Indian Public Health Standards CInI: Collectives for Integrated Livelihood Initiatives 5  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Content Page Chapters No. Executive Summary 7 Chapter - 1 Introduction 10 Chapter - 2 Methodology 13 Chapter - 3 Burden of NCD and Cancer in Study Population 18 Chapter - 4 General Health Seeking Behaviour for Different Health Conditions 23 Chapter - 5 Health seeking Behaviour for Menstrual Hygiene Management 29 Chapter - 6 Health Seeking Behaviour for Cervical Cancer 40 Chapter - 7 Health seeking Behaviour for Breast Cancer 52 Chapter - 8 Knowledge and Attitude for MHM, Cervical Cancer and Breast Cancer 61 Chapter - 9 Supply of Healthcare Services in Jharkhand 80 9.1 Health Insurance Status 82 9.2 Health Insurance Provider 83 9.3 General Health Services – Source of supply 85 9.4 Requirement of medicines 86 9.5 Supply status of Medicines 87 9.6 Source of treatment 87 9.7 Distance travelled to attend health events 91 9.8 Payment status of events 93 Chapter - 10 IPHS & Functioning of PHC’s/SHC’s in Jharkhand 96 Chapter - 11 National Policies on NCD’s and Cancer and its status in Jharkhand 107 Chapter - 12 Collaborative efforts & functioning of NGO for the Management of NCDs and Cancer in Jharkhand 112 6  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Executive Summary Access to healthcare services is a fundamental pillar of a well-functioning healthcare system. A recent study conducted by IMS Health has identified four key dimensions that define healthcare access: physical accessibility to healthcare facilities, the capacity of these facilities to serve patients, the quality of care provided by healthcare professionals, and the affordability of healthcare services. These dimensions collectively determine the accessibility of healthcare within a specific geographical area. In the context of managing chronic and non-communicable diseases, healthcare access plays a pivotal role. The prevalence of non-communicable diseases, such as diabetes and hypertension, is on the rise, necessitating a systematic approach from early screening to treatment. Efforts to promote early screening and timely intervention for non- communicable diseases, including cancer, have faced challenges. Treating conditions like cancer and heart disease in public hospitals can pose a significant financial burden, often straining a country's GDP per capita. This financial hardship is especially pronounced for cancer patients, who frequently struggle to find adequate healthcare financing. Cancer presents a substantial challenge in this context, with a significant portion of cases in India occurring among women. Breast and cervical cancer are prominent, with early detection offering the potential for higher survival rates. However, Indian women face lower five-year survival rates for breast cancer compared to their counterparts in the United States. Cervical cancer, which is largely preventable, remains prevalent among Indian women, primarily linked to high-risk human papillomaviruses (HPV). Implementing effective primary and secondary prevention strategies, such as HPV vaccination, holds the promise of preventing the majority of cervical cancer cases. Jharkhand faces a significant burden of non-communicable diseases (NCDs), with higher rates of hypertension and diabetes than the national average. Additionally, breast, cervical, oral, and lung cancer are prevalent in the region. This executive summary provides an overview of the healthcare landscape in Jharkhand, emphasizing the need for improved screening and prevention strategies, especially for cancer. It also highlights the initiatives and programs in place to address these challenges. The Indian Council of Medical Research (ICMR) reports that the prevalence of hypertension in Jharkhand is 25.3%, surpassing the national average of 25%. Similarly, the prevalence of diabetes in Jharkhand stands at 8.6%, higher than the national average of 7.8%. Furthermore, the National Family Health Survey (NFHS-5) data highlights the commonality of breast, cervical, oral, and lung cancers in the region. Despite the 7  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) high prevalence of cancer, screening rates in Jharkhand remain low. This underscores the critical need for enhancing screening and early detection practices, particularly for breast and cervical cancer. Improving screening rates can pave the way for more effective management systems, even in resource-constrained settings. Effective strategies for combating the growing cancer burden involve community awareness campaigns and preventive measures such as menstrual hygiene management and tobacco control. Additionally, achieving higher screening rates is pivotal for timely cancer diagnoses and treatment initiation. To address the rising cancer burden, CINI, with support from the Crypto Relief Fund and in technical partnership with Karkinos Healthcare, has initiated the "Healthcare Support to Rural and Tribal Communities in Jharkhand" project. This initiative encompasses community awareness about menstrual hygiene management, common cancers in women, and cancer screening, diagnosis, and treatment programs. CiNI’s program can bring much anticipated changes in the knowledge and awareness in NCD and cancer and may contribute significantly to the objectives of key national healthcare initiatives, including the National Cancer Control Programme (NCCP), National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), and District Cancer Control Programme (DCCP). These programs focus on prevention, early detection, and comprehensive disease management. Implementing these programs is essential to effectively address the rising burden of NCDs in Jharkhand. These initiatives prioritize prevention, early detection, and public awareness, leading to improved healthcare infrastructure and reduced long-term healthcare costs. CiNI’s program was found to be effective by improving the screening rate of cancer by more than 30% and awareness rate of more than 60%. This program also demonstrated the possibility of sustaining the program by involving the members of Farm Produce Company (FPC) who are the earning members in the rural community. This program was also successful in changing the knowledge, attitude and perception of the community in cancer and NCDs. In conclusion, the prevalence of NCDs, particularly cancer, in Jharkhand underscores the urgency of effective healthcare interventions. Initiatives like CINI's project, coupled with national programs and local engagement, offer hope for better disease management and improved health outcomes in the region. Rigorous evaluation and data-driven decision-making 8  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) are essential for the success of these programs. This study included a survey of 1150 beneficiaries to understand the service delivery and perceived value proposition for primary care of cancer in terms of the utilization of healthcare services which includes screening, diagnosis and desired health outcome from the people’s perspective. 9  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Chapter - 1 Introduction Access to healthcare services is a fundamental cornerstone of any effective healthcare system. Enhancing a healthcare system requires a substantial improvement in healthcare access. A recent study conducted by IMS Health has identified four critical dimensions that define the degree of healthcare access in a given region. These dimensions include physical accessibility to healthcare facilities, the capacity of these facilities to serve patients, the quality of care provided by healthcare professionals, and the affordability of healthcare services, including associated consumables. These factors collectively determine the accessibility of healthcare within a specific geographical area. The Role of Healthcare Access in Managing Chronic Diseases: Healthcare access plays a pivotal role, particularly in the context of chronic and non- communicable diseases. On one hand, the prevalence of non-communicable diseases is rapidly increasing, gradually replacing the burden of communicable diseases. On the other hand, managing non-communicable diseases, such as diabetes mellitus and hypertension, necessitates a systematic approach, spanning from early screening to treatment. Despite the continuous efforts to promote early screening and timely intervention, the impact on non-communicable diseases, including cancer, has not been as substantial as desired. Notably, the cost of treating conditions like cancer and heart disease in public hospitals can be an enormous burden, often reaching a significant percentage of a country's gross domestic product (GDP) per capita. This financial burden is particularly significant for cancer patients, as healthcare financing mechanisms are often inadequate, leading many patients to seek distressed means to finance their treatment. Cancer, in particular, poses a considerable challenge. More than half of all cancer cases in India are among women, with breast and cervical cancer accounting for a significant portion of new cancer incidences. The survival rates for these cancers, especially when detected early, can be significantly higher. However, Indian women with breast cancer, for example, have a substantially lower five-year survival rate compared to women in the United States. Similarly, cervical cancer is a preventable disease, yet it remains one of the most common forms of cancer among Indian women, primarily linked to high-risk human papillomaviruses (HPV). 10  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Implementing effective primary and secondary prevention strategies, such as HPV vaccination, can prevent a vast majority of cervical cancer cases. The Prevalence of Non-Communicable Diseases in Jharkhand: Jharkhand faces a high prevalence of non-communicable diseases. According to the Indian Council of Medical Research (ICMR), the prevalence of hypertension and diabetes in Jharkhand is higher than the national average. Furthermore, an analysis of the National Family Health Survey (NFHS-5) data revealed that breast cancer, cervical cancer, oral cancer, and lung cancer are among the most common types of cancer reported in the region. According to a study conducted by the Indian Council of Medical Research (ICMR), the prevalence of hypertension in Jharkhand is 25.3%, which is higher than the national average of 25%. The prevalence of diabetes in Jharkhand is 8.6%, which is also higher than the national average of 7.8%. Additionally, we aimed to analyze the NFHS-5 data to provide an updated assessment of the prevalence of cancer in Jharkhand. The NFHS-5 data for Jharkhand included a sample of 16,516 households and 27,586 individuals. The most common types of cancer reported were breast cancer (17.1%), followed by cervical cancer (12.5%), oral cancer (11.6%), and lung cancer (8.7%). As per the NFHS 5 data for the year 2020-21, the screening of cancer in Jharkhand is comparatively very low (0.5% for cervical cancer, 0.1% for breast cancer, 0.2% for oral cancer among women) as compared to the screening rate in India (1.9% for cervical cancer, 0.9% for breast cancer, 0.9% for oral cancer among women). As per the rules of half for chronic disease management, high screening rate will provide the opportunity to establish a better management system in a low resource setting like ours. The high prevalence of NCDs with special reference to breast and cervical cancer as well as Menstrual Hygiene Management highlights the need for improved screening and prevention strategies for women in Jharkhand. Other less common types of cancer reported included stomach, colon, and prostate cancer. Low Screening Rates and the Importance of Early Detection: Despite the high prevalence of cancer, screening rates in Jharkhand remain relatively low compared to national averages. This discrepancy highlights a critical need for improving screening and early detection practices, especially for breast and cervical cancer. Increasing 11  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) screening rates can create opportunities to establish more effective management systems, even in resource-constrained settings. Strategies for Preventive Cancer Management: To combat the growing challenge of cancer, two primary approaches have been considered at the primary healthcare level. Firstly, there is an emphasis on improving community awareness and practices related to preventive measures, including menstrual hygiene management and the consumption of tobacco. Secondly, achieving higher screening rates is essential for confirming diagnoses and initiating timely treatment for cancer cases. Initiative by CINI and Partners: To address the increasing cancer burden, CINI, with support from the Crypto Relief Fund and technical partnership with Karkinos Healthcare, has launched a project called "Healthcare Support to Rural and Tribal Communities in Jharkhand." This project adopts a two-pronged approach: raising community awareness about menstrual hygiene management, common cancers in women, and conducting cancer screening, diagnosis, and treatment programs. The Need for Evaluation and Innovation: While such programs hold promise, their impact on the community and any existing gaps need to be rigorously evaluated. Identifying and strategically addressing additional community needs is crucial. Successful implementation of such initiatives may pave the way for an innovative model for managing cancer at the primary level of healthcare management. 12  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Chapter - 2 Methodology CINI runs the project in 7 blocks of 6 districts in Jharkhand for the areas of primary and preventive Cancer Care and Menstrual Hygiene Management in Dhalbhumgarh and Gurabanda in East Singhbhum, Murhu in Khunti, Churchu in Hazaribagh, Tundi in Dhanbad, Jama in Dumka and Palojori in Deoghar. While the impact of primary and preventive care for cancer and Menstrual Hygiene Management needs to be assessed in the intervention blocks, the situation also needs to be evaluated in the controlled blocks for a clear cut understanding of the gaps and also the implementation plans. Thus, the methodology involves conducting a case control study involving 3 blocks in the interventional areas and 3 blocks from the non-interventional areas from the same district. The control blocks from the same district was selected to ensure the low variation in the socio- economic impact on the study results. 2 blocks (one from the intervention block and one from the non-intervention block) from districts of Khunti,,Hazaribagh, East Singhbhum and Dumka was selected to be included in the study. Sample Size- Total sample size for the study was calculated by using the following formula- Where, S= Sample size X2= Chi-square value for alpha (3.84 for 95% of CI) N= population size (population covered in the project area of 7 blocks is around 7.90 Lakhs) P= Population proportion (estimated proportion of patients are satisfied with the service delivery. it is assumed to be 75%; it is assumed that the probability of a patient is provided with all desired services defined in the project) D= degree of accepting error in the proportion (taken as 7% or 0.07) Thus the total sample size is estimated to be 196 to be collected from the 6 blocks. To round off, a sample of 200 would be taken for the study. Of the 200 samples, 100 each would be collected from the interventional and non-interventional blocks. 13  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Now the sample size of 100 would be distributed among all the 3 blocks through the PPS (Probability Proportion to Size) principle. In other words, the sample size would be more for the blocks where the patient turnover is high and vice versa. Si= S * (pi/P*100) Where, Si = Sample for the ith block pi = Total population served in the ith block (or the total population) P = Total service delivered in the project (or total population in the project area) Sampling Method- It is assumed that health seeking behavior is directly related to the distance and accessibility to the nearest tertiary care. So, out of the 6 districts where CInI runs the project, based on the distance from Ranchi we have selected 4 districts and 4 Blocks from each as mentioned below – Districts Blocks Total No. of Villages No. of Villages (as per census 2011) covered by CinI Ranchi Dhanbad (164 Km) - - - Deoghar (254 Km) - - - Khunti (34 Km) Murhu 141 102 Hazaribagh (104 Km) Churchu 40 33 Dumka (288 Km) Jama 320 199 East Singhbhum (182 Km) Guruband 82 64 Based on the distance (Nearest to farthest) we have selected 4 Districts and 4 Blocks in each districts and we have selected 4 villages in each block (2 case villages where CInI has done some project activities and 2 control villages that has not been covered by CInI from each block on random basis. 2 control (non-intervention) villages were selected from two blocks as per the following criteria 1. Same block where CInI project is on but the selected village has not yet covered under the CInI project activities 2. Different block where CInI project is not functional 50 households were contacted in each Blocks. Based on random sampling, following villages were selected in each Block- 14  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Blocks Villages covered by CInI Villages not covered by CInI (randomly selected) (randomly selected) Murhu (Dist- Khunti)- Kundi Bartoli Interventional Gangira Gajgaon Karra (Dist- Khunti) – Non- Mitkora Interventional Churchu (Dist-Hazaribaug) - Jarwa Interventional Hendegra Tasnalo Dadi (Dist-Hazaribaug ) – Non- Kura Interventional Jama (Dist-Dumka) - Panchrukhi Interventional Basjora Bhorabadar Palojori (Dist-Dumka) – Non- Kunjbana Interventional Gurabanda - Interventional Muchiyasai Tal Pathar Para Pandra pathar Arjunbera Selection of Households- The sampling of households is done through systematic random sampling. For example, In Churchu Block, Number of villlages (n) = 40 No. of households to be surveyed = 13 K = Number of Villages in Block/ 13 (No. of households to be surveyed in each village) Therefore, K = 40/13 = 3.1 (Where, K = n/13) So, every 3rd house in the village will be surveyed. Similarly, the systematic random sampling for all the villages was done. Data Collection - Questionnaire: All the beneficiary information was collected through a structured questionnaire. Questions in the questionnaire covered all the information specified in the objectives. 4 sets of questionnaire were developed to collect information related to the objectives- Household questionnaire - The Household questionnaire gathered demographic and socioeconomic data, which can help assess factors related to healthcare access and utilization. 15  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) This information aligned with the broader objective of evaluating healthcare access, including affordability. It also included questions about healthcare-seeking behavior, which can be related to the capacity of healthcare units to serve patients and the quality of care provided in terms of NCD management. Questions related to the prevalence of NCD and screenings in the household provided insights into healthcare utilization and early detection. Few basic contents were:  Demographic information: Age, gender, education, income, etc.  Healthcare-seeking behavior: How often household members seek healthcare, where they seek it, and reasons for seeking care.  Information about existing health conditions and screenings: Whether household members have been screened for diseases like cancer, diabetes, and hypertension.  Financial aspects: Questions about healthcare costs, insurance coverage, and any out-of- pocket expenses. MHM Questionnaire - This questionnaire aligned primarily with the objective of creating community awareness regarding menstrual hygiene management. It also included questions related to the prevalence of cervical cancer, as there's a link between menstrual hygiene practices and cervical cancer. Few basic contents were:  Menstrual hygiene practices: Questions about the type of menstrual hygiene products used, frequency of change, and disposal methods.  Awareness of cervical cancer and screening: Inquiries about awareness and knowledge of cervical cancer and screening methods. Breast & Cervical Questionnaire - This questionnaire was directly tied to the objective of raising awareness about common cancers in women, particularly breast and cervical cancer. It included questions related to screening for breast and cervical cancer, and KAP based questions which aligned with the need to improve screening rates. The questionnaire was drafted in local language also and was sent for approval to CInI team before the finalization for the field study. Secondary Data Collection The secondary source of data collection was mainly through Structure literature review. Information from CInI as well as desk research on the provided information was also done to get the insights related to project. Literature review/ Google search was done on aspects like 16  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) support to improve the delivery of NCD services related to HT/DM/Cancer/MHM in India & Jharkhand with relevant keywords. Also, other organizations involved were searched through journal/magazines/ Online publication etc. A thorough study of national & state policies like NPCDCS, NCCP, Training manuals, IPHS, Annual report, PIP of MoHFW and other Govt. documents was done in terms of awareness, screening, clinical management, referrals, training & capacity building to compare with the existing standards in Jharkhand. *Questionnaires are available in Annexure 2.1-2.4 * Field Checklist are available in Annexure 2.5 17  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Chapter - 3 Burden of NCD and Cancer in Study Population The prevalence of NCDs in Jharkhand is high. According to a study conducted by the Indian Council of Medical Research (ICMR), the prevalence of hypertension in Jharkhand is 25.3%, which is higher than the national average of 25%. The prevalence of diabetes in Jharkhand is 8.6%, which is also higher than the national average of 7.8%. Additionally, we aimed to analyse the NFHS-5 data to provide an update on the prevalence of cancer in Jharkhand. NFHS5 fieldwork for Jharkhand was conducted from 20th January 2020 to 21st March 2020 prior to the lockdown and from 5th December 2020 to 18th April 2021 post lockdown by Development and Research Services Pvt. Ltd. (DRS). Information was gathered from 22,863 households, 26,495 women, and 3,414 men. As per the NFHS 5 data for the year 2020-21, the screening of cancer in Jharkhand is comparatively very low (0.5% for cervical cancer, 0.1% for breast cancer, 0.2% for oral cancer among women) as compared to the screening rate in India (1.9% for cervical cancer, 0.9% for breast cancer, 0.9% for oral cancer among women). As per the rules of half for chronic disease management, high screening rate will provide the opportunity to establish a better management system in a low resource setting like ours. The high prevalence of NCDs with special reference to breast and cervical cancer as well as Menstrual Hygiene Management highlights the need for improved screening and prevention strategies for women in Jharkhand. Other less common types of cancer reported included stomach, colon, and prostate cancer. The current research exercise tries to check the burden of the NCDs like diabetes, hypertension and cancer in the study population. Although the current study is not designed to measure the prevalence rate, the burden of NCD in the study population is explained through the prevalence rate calculated from the data collected on the reported status of diabetes, hypertension and cancer by the respondents. For calculation of prevalence of a particular health condition, all the respondents of more than 20 years are considered. 18  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Prevalence of Diabetes in study population The overall prevalence of diabetes among the respondents of 20 years and above in the study population was found to be 5.2%. PREVALENCE OF DIABETES BY GENDER prevalence of diabetes by age 8.6% 6.2% 3.9% 2.0% Male Female 20 - 40 YEARS MORE THAN 40 YEARS The variation in the prevalence rate is noticed by age and gender. The prevalence rate is more among female respondents in the study population and so also among the respondents in the age group of 40 years and above. Thus, the demand for the healthcare services for diabetes would be more from female and elderly people and therefore easy access to the diabetes related services would provide better outcome in terms of management of the disease. Diabetes & Risk Factors in the study population The current study considers couple of risk factors like practicing of exercise, smoking, consumption of alcohol and hereditary factors for corelating with the prevalence rate in the study population. Respondents with no exercise were having a prevalence rate of 4.6% and people doing exercise had a prevalence rate of 6.8%. Such a difference could be since some of Prevalence rate by the presence of the people generally start doing exercise diabetes as hereditary after being diagnosed with diabetes. Don't Know 5.7% Similar pattern is also observed in case of No 3.8% consumption of alcohol. However the Yes 10.8% prevalence rate of diabetes was found to be more among those consuming tobacco (5.9%) than those not consuming tobacco (5%). 19  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) The prevalence rate was found to be more (10.8%) among those who have the history of diabetes as a hereditary problem. However, there is an unmet need for screening and diagnosis of diabetes among those having some risk factors. Around 58% of the respondents in the study population have not yet screened for diabetes who are in the age group of 20 years and above. Around 64% of the respondents who consume tobacco have not yet screened for diabetes and this proportion is 78% for consuming alcohol and 61% for those not doing any exercise. The demand for basic health services for the screening of diabetes was found to be very low in the community especially those with some risk factor. On the other hand, the screening rate is more among the respondents with no risk factor. Prevalence of hypertension in study population The overall prevalence of hypertension among the respondents of 20 years and above in the study population was found to be 11.7%. prevalence of hypertension by prevalence of hypertension by Gender age 13.3% 26.9% 10.3% More than 60 Years 40-60 Years 19.2% 20 - 40 years 2.8% Male Female The variation in the prevalence rate is noticed by age and gender. The prevalence rate is more among male respondents (13.3%) in the study population and so also among the respondents in the age group of 40-60 years (19.2%) and in the age group of 60 and above (26.9%). Thus, the demand for the healthcare services for hypertension would be more from elderly people 20  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) and therefore easy access to the hypertension related services would provide better outcome in terms of management of the hypertension. Hypertension & Risk Factors in the study population While age is a natural risk factor for the NCDs like hypertension, the current study has evaluated the prevalence of hypertension by few risk factors like tobacco, alcohol and not having regular exercises. 12.0% 18.2% 22.0% 11.6% 9.7% 10.2% Consumption of No consumption Consumption of No consumption Alcohol of Alcohol No exercise Exercise Tobaco of tobaco Prevalence of Hypertension by Risk Factors In the study population, the prevalence rate is not significantly different among those who do exercises and who do not. But the prevalence rate of hypertension varied significantly for the consumption of tobacco and alcohol. The prevalence rate is double among those who consume either alcohol or tobacco. Around 50% of the total respondents in the age of 20 years and above have not been screened for hypertension. The matter of concern is that more proportion of respondents having some risk factor have not yet been screened. 59% of the respondents have not yet screened for hypertension who consume tobacco against 49% who don’t consume tobacco. Similarly, 76% of the respondents have not yet been screened for hypertension who consume alcohol as against 44% who do not consume alcohol. Based on the prevalence rate of hypertension among the population, a significant number of people remain undiagnosed in 21  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) the study population. Such unmet needs need to be addressed by improving the awareness and pursuing the community for mandatory screening. Prevalence of Cancer in study population There are 2 cases of cancer identified during the study of 208 households during the survey period of August 16 to 21, 2023. First case was from Gurabanda, East Singhbhum, a female of 70 years’ old. The second case was from Jama, Dumka, a female of 30 years old. This translates to overall prevalence of cancer among the respondents of 20 years and above in the study population to be 1%. These 2 cases were detected among women and no one of them have any risk factor of consumption of alcohol or consumption of tobacco. The detection was done during the community level cancer programinitiated by CINI. This brings a very important aspect of mandatory cancer screening in the community. As per the data released by NFHS-5, the screening rate for breast cancer, cervical cancer and oral cancer is very low around 1% in Jharkhand. However, the survey found a better rate of screening and risk assessment among the study population in Jharkhand. The high proportion of screening for cancer is clearly due to the program being run by CINI for the awareness and screening of breast cancer, cervical cancer and oral cancer. Therefore, such programme would definitely boost the screening rate in the community and thus the overall management and prevention of cancer. 30% people in the study population have already been screened for Cancer 22  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Chapter - 4 General Health Seeking Behaviour for Different Health Conditions Demand for healthcare services is a critical factor for the better health in the community. While the demand for acute health conditions is dependent on the visible severity, the demand for chronic healthcare services is an outcome of overall knowledge and attitude of the population on the specific disease. The demand for services of non-communicable disease (NCD) is manifold including basic risk assessment, screening, conformity diagnosis, treatment and adherence of the treatment. To manage all these needs a complex engagement plan in the community and thus the health seeking behaviour of the community for the NCD is important to study before devising any strategy for the same. Understanding health-seeking behaviour is crucial for effective healthcare planning and delivery. In Jharkhand, a state grappling with a high burden of Non-Communicable Diseases (NCDs), including cancer, it is imperative to analyze how individuals and communities seek healthcare services and manage these diseases. Challenges in Health Seeking Behaviour: One of the primary challenges is the lack of awareness about NCDs, their risk factors, and early symptoms, including those related to cancer. In many parts of Jharkhand, communities, especially in rural areas, may not recognize the signs and symptoms of NCDs, leading to delayed diagnosis and treatment. Accessibility to healthcare facilities remains a significant barrier, particularly in remote and tribal areas of Jharkhand. Long distances to healthcare centers, poor transportation infrastructure, and inadequate healthcare facilities can deter individuals from seeking timely care. Socioeconomic disparities in Jharkhand play a vital role in health-seeking behavior. Limited financial resources often force individuals to delay or forgo medical consultations and treatments. Additionally, cultural and social norms can influence decisions about seeking healthcare. Stigma surrounding cancer and other NCDs can lead to avoidance of healthcare services. Misconceptions about these diseases, their causes, and available treatments persist in some communities, hindering early diagnosis and management. 23  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Overall demand for healthcare services In the study population, 44% of the respondents have obtained some medical services during one year preceding the survey. Proportion of respondents sought healthcare services in last one year Multiple times during the year 3% More than a year back 4% Between 9-12 Months 5% Between 6-9 Months 10% Between 3-6 Months 19% During last 3 Months 59% Of those who have sought healthcare service in last one year, around 97% have taken the services once whereas 3% people have taken the medical services multiple times during the year. Maximum people have sought the services during last three months and the proportion keeps on declining with time of taking medical service. Although the data reflects a peculiar pattern, which may be contributed by the factors like memory lapses. Most of the people who have sought for the medical services, 41% had for cold/cough and fever and 14% had it for other acute conditions. Proportion of respondents sought treatment by Disease More than one, 30% Cough/Cold/fever, 41% Other, 14% Diabetes, 7% CVD, 1% Cancer, 1% Blood Pressure, 5% It is important to note that more than 14% of the respondents have sought treatment for NCDs like diabetes, hypertension and cancer and around 30% respondents have got the treatment for 24  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) more than one disease. This indicates more than 14% of the people have demanded the treatment for NCDs and a significant proportion of them have not continually seeking treatment as 97% of the respondents have gone one once to get the treatment for their health condition. The seeking healthcare services for NCDs in continuous basis is important for adhering to the treatment protocol which is detrimental for the outcome of the disease progression and control. Addressing the low adherence to the 14% or more respondents have sought treatment NCD treatment is very critical for NCDs. before implementing any innovative NCD and cancer programe as the 3% of the respondents have only gone more than primary and preventive intervention once to the healthcare centre to get the treatment in the community. If such issues are Adherence to NCD treatment is a major issue in not addressed as a part of the the Study area. programme, then the primary and preventive programme may lead to generate a potential group of people with the risk factors which may not be managed well in the healthcare value chain. Source of healthcare services Given a choice to choose the source of healthcare services, 77% of the respondents have opined to get it from private sources whereas around 55% have said to get it from government facilities. However, when they really need the healthcare service, most of them depend on private sector service providers and very less on government facilities. Private healthcare providers are the major source of seeking treatment by the respondents in the study area. More than three fourth of the demand for health care services are managed by private clinics and around 15% of the demand is met by the government healthcare system. Proportion of respondents by Treatments for Diabetes and HT by source of seeking treatment Type of Insitution 86% 77% 69% 14% 19% 12% 7% 0% 3% 4% 2% 2% 5% GOVT INSTITUTES PVT CLINICS OTHERS Diabetes HT 25  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) People in the study area predominantly depend on Private facilities for the treatment of NCDs like diabetes and hypertension. More than 85% respondents for diabetes and around70% of the respondents for hypertension take treatment from private facilities. This indicates that the role of private clinics is effective and sustainable for the management of NCD in the study population. More than 90% people pay for availing their healthcare services. Distance travelled for healthcare services Around 70% people travel more than 10 kilometres for receiving the healthcare services, whereas 23% travel between 5 to 10 kms and only 8% people travel less than 5 kms. For the treatment of diabetes 70% people travel more than 10 kilometres and for the treatment of hypertension 90% people travel more than 10 Kms. Level of satisfaction for the current healthcare services Most of the people are happy with the current situation of availing the healthcare services for their health conditions. Around 93% people have rated the quality of service either “4” or “5” in the likert scale of “1-5”, “5” being the best and “1” being the worst. Only 1% have given a score of “2” and 6% have opted for score “3”. Similar pattern is observed in case of diabetes and hypertension treatment. level of Satisfaction for the services related to diabetes and hypertension 97% 75% 25% 3% Highly Satisfied Somewhat satisfied Diabetes HT 26  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Healthcare services specific to diabetes and hypertension Diabetes Of the total people found to be diabetes, 74% of them On Medication for Diabetes had been diagnosed with diabetes more than a year from the date of the study and 26% were diagnosed Yes, within a year preceding the survey. However, only 23% No, 23% of the diabetes patients are on medication. 76% This indicates a very low proportion of people are on medication after being diagnosed with diabetes. Therefore, this is a matter of great concern that after the primary screening and diagnosis, it is still a challenge to put the people on medication. However, the positive aspect is the high rate of adherence of the medication (95%) for those who are already on medication. Again one quarter of the diabetes patients follow various precautions like diet, exercise and natural means to control diabetes. Hypertension Of the total people found to be hypertensive, 40% of Adherance of HT Medication them had been diagnosed with hypertension more than No, 22% a year from the date of the study and another 40% Yes, were diagnosed within a period of 3 months preceding 78% the survey. Around 50% of the hypertension patients are on medication. 27  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Healthcare services specific to Oral Cancer Around 10% of the study population has already been completed the screening for the oral cancer. This is impressive against the NFHS-5 data for Jharkhand which has recorded a screening rate of around 1%. This could be due to the efforts put by NGOs like CINI through dedicated program % of respondents willing for implementation. This is screening of Oral Cancer in next 6 months evident from the fact that more than 70% of the Yes 42% screening was done within 18% one year preceding the No survey. Around 60% of the Don't know 40% screened population was found to be normal where as 40% of the screened population were counselled and referred to further diagnosis process. More than 40% of the respondents had a positive response to go for a screening of oral cancer. The demand for healthcare services is bound to improve with a regular and engaging programme at the community level. 28  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Chapter - 5 Health seeking Behaviour for Menstrual Hygiene Management In Jharkhand, many women lack essential information about proper menstrual hygiene management (MHM) practices. Educating women, adolescents, and families about the importance of menstrual hygiene, the use of sanitary products, and appropriate disposal methods is crucial. Although there has been progress in making sanitary products available, some areas still face limited access. Ensuring the affordability and accessibility of these products is vital for promoting healthy MHM. It's essential to encourage women to seek guidance from healthcare facilities like primary health centers and community health workers. Healthcare providers need sensitive training to address MHM concerns effectively. Using counseling, educational resources, and involving community influencers like health workers and teachers can help destigmatize menstruation. Tailoring MHM initiatives to specific communities by recognizing regional cultural practices is crucial. Regular evaluation of MHM programs and health-seeking behaviors is necessary for their effectiveness. Understanding health-seeking patterns is essential for improving overall health outcomes, especially in the diverse state of Jharkhand where healthcare access and awareness levels vary widely. Analyzing MHM health-seeking behavior is a multidimensional effort, including assessing awareness, education, knowledge levels, and resource access, all of which provide valuable insights for shaping effective initiatives. Challenges in Health Seeking Behavior for MHM: In Jharkhand, many women lack essential information about proper menstrual hygiene management (MHM) practices. Educating women, adolescents, and families about the importance of menstrual hygiene, the use of sanitary products, and appropriate disposal methods is crucial. Although there has been progress in making sanitary products available, some areas still face limited access. Ensuring the affordability and accessibility of these products is vital for promoting healthy MHM. It's essential to encourage women to seek guidance from healthcare facilities like primary health centers and community health workers. Healthcare providers need sensitive training to address MHM concerns effectively. Using counseling, educational resources, and involving community influencers like health workers and teachers can help destigmatize menstruation. Tailoring MHM initiatives to specific communities by recognizing regional cultural practices is crucial. Regular evaluation of MHM programs and health-seeking 29  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) behaviors is necessary for their effectiveness. Understanding health-seeking patterns is essential for improving overall health outcomes, especially in the diverse state of Jharkhand where healthcare access and awareness levels vary widely. Analyzing MHM health-seeking behavior is a multidimensional effort, including assessing awareness, education, knowledge levels, and resource access, all of which provide valuable insights for shaping effective initiatives. Training on MHM in the Study Population Proportion of Respondents received Disrictwise Proportion of Respondents Training on MHM in the Study received Training on MHM in the Population Study Population 54% Dumka 46% 22% East Singhbhum 18% 82% 78% Hazaribaug 11% 89% 8% Khunti 92% 0% 20% 40% 60% 80% 100% Training on MHM % Yes Training on MHM % No Training on MHM % No Training on MHM % Yes It appears that MHM training has been conducted in a majority of the districts/blocks. There is significant variation among districts/blocks regarding MHM training. Khunti and Hazaribaug districts have exceptionally high training rates, indicating effective coverage in these areas. East Singhbhum is showing a relatively 78% respondents from the study good coverage as well. population sought the training on MHM This could signify potential gaps in awareness Exceptionally District Dumka is showing and education about menstrual hygiene in this some challenges in receiving MHM Training area. Overall, the majority of respondents’ in Districtwide Proportion of Respondents study population have received MHM training, shows the less coverage in receiving training on MHM in the Non-Intervention villages of indicating efforts to promote awareness and CInI. education regarding menstrual hygiene. 30  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Frequency of Training for MHM (In Last Year) Overall Proportion of Respondents Districtwise Proportion of Respondents received Training >3 times (Last year) received Training >3 times (Last year) on MHM in the Study Population on MHM 26% 38% 21% Dumka East Singhbhum 35% 17% 19% Hazaribaug 40% Khunti 11% Once Twice Thrice >3 Times 0% 10% 20% 30% 40% It can be inferred that the percentage of the population receiving training more than three times varies across different districts/blocks in the study population. It can be concluded that Hazaribaug has the highest percentage of people who have received training more than three times for MHM, followed by East Singhbhum, Dumka, and Khunti. 26% of the study population received training more frequently, attending sessions more than three times in the last year Overall, most respondents in the study population received training more frequently indicating efforts of CInI to promote awareness about MHM. Counselling/ Consultation on MHM Proportion of Respondents Disrictwise Proportion of Received Conselling On MHM in Respondents received Conselling the Study Population on MHM NO, 20% Dumka 64% East Singhbhum 78% YES, 80% Hazaribaug 81% Khunti 94% 0% 50% 100% 31  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) The data reveals disparities in access to counseling or consultation on Menstrual Hygiene Management (MHM) across surveyed districts/blocks in Jharkhand. Khunti stands out with the highest accessibility followed by Hazaribaug, East Singhbhum and Dumka. On average, 80% of respondents in the study population have access to MHM counseling, indicating reasonably widespread accessibility of these services. Despite variations between districts, the overall data suggests that a significant portion of the population in Jharkhand has access to crucial MHM support through counseling. Frequency of Counselling/ Consultation done on MHM (In Last Year) Proportion of Respondents sought Districtwise Proportion of Consultation >3 times (Last year) on Respondents received Conselling >3 MHM in the Study Population times/last year > 3 times, 14% Dumka 6% Thrice, Once, 18% 19% 49% East Singhbhum Twice, 19% 24% Hazaribaug Khunti 7% 0% 5% 10% 15% 20% 25% The data demonstrates notable disparities in the frequency of counseling on Menstrual Hygiene Management (MHM) across surveyed study population. Hazaribaug stands out with the highest rate, where 24% of respondents received counseling more than three times in the last year, followed by East Singhbhum at 19%. In contrast, both Khunti and Dumka have lower percentages, with 7% and 6% of respondents receiving counseling more than three times, respectively. Collectively, only 14% of respondents across the study population received frequent counseling on MHM, highlighting that a relatively small segment of the population had recurrent access to these services. 32  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Usage of Sanitary Napkin Districtwise Proportion of Respondents for the usage of Sanitary Napkins during Menstruation 15% Dumka 85% 7% East Singhbhum 93% 2% Hazaribaug 98% 0% Khunti 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Use of Sanitary Napkin NO Use of Sanitary Napkin YES The data reveals significant disparities in the usage of sanitary napkins among respondents in different districts/blocks of the region. Khunti exhibits a 100% usage rate, indicating universal adoption among its respondents, making it the highest in the region followed by Hazaribaug, East Singhbhum and Dumka. These variations in usage rates of sanitary napkins during menstruation could be attributed to factors like awareness campaigns, accessibility of sanitary napkins, education levels, cultural beliefs, and economic conditions. Khunti and East Singhbhum's high usage rates could be linked to effective awareness programs by CInI like MHM training and counselling as well as better availability of sanitary products. Practice of cleanliness during Menstrual Cycle The implementation of the Menstrual Hygiene Districtwise proportion of respondents in practicing of Management (MHM) program by CInI cleanliness during menstrual cycle appears to be remarkably successful, evident Dumka, Khunti, from the high rates of cleanliness practices 97% 98% during menstruation in the study population. East Khunti stands out with an impressive 98% Singhbhum, Hazaribaug, 88% 94% adherence to proper hygiene practices. The district of Dumka also showcases the 33  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) effectiveness of the program with a commendable 97% compliance rate. Additionally, Hazaribaug, another district demonstrates substantial success of training program on MHM with a 94% adoption rate. These figures highlight the positive impact of CInI's interventions, promoting awareness and education around menstrual hygiene practices. Awareness on Disposal of Sanitary Napkins Districtwise Proportion of Awareness on Disposal of Sanitary Napkins 79% 98% 90% 94% Khunti Hazaribaug East Singhbhum Dumka The Menstrual Hygiene Management (MHM) program has demonstrated significant success, as evident from the data provided. 98% of respondents in Khunti, claim to be aware about proper disposal of sanitary napkins where the CInI’s program is active, showcasing the program's efficacy in promoting responsible menstrual waste management. 94% of respondents in Hazaribaug, report proper disposal practices, reflecting the positive impact of CInI's interventions. 90% compliance followed in East Singhbhum, indicating the program's success in this district as well. While Dumka records a slightly lower rate at 79%, it still represents a considerable portion of the respondents practicing proper disposal, although comparatively lower than other areas. Accessibility for the Products for MHM The accessibility of the products for Menstrual hygiene in the study population reflects a positive scenario. It illustrates a relatively widespread accessibility of Menstrual Hygiene products across 34  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) these districts, indicating positive strides in Districtwise Proportion of Accessibility for the Products of Menstrual Hygiene ensuring menstrual hygiene resources for most of the population. Hazaribaug 91% 97% emerges as a standout district, where 100% of respondents report the accessibility of 96% Menstrual products, indicating 100% comprehensive access to menstrual hygiene resources. Khunti and East Singhbhum Khunti Hazaribaug East Singhbhum Dumka closely follow accessibility, showcasing a robust distribution network of Menstrual Hygiene products in these areas. Even in Dumka, where accessibility is slightly lower, still reports access to these essential products. These variances in accessibility can be attributed to a combination of factors, including government initiatives, efforts by non-governmental organizations (NGO), and the efficiency of local distribution networks (FPCs). Knowledge of various Products for MHM: Districtwise Proportion of Respondents about Knowledge of Products for MHM 97% 90% 46% 51% Sanitary Napkin Tempons Menstrual Cup Cotton pad The data from the study population indicates a high awareness level (97%) about sanitary napkins, which are commonly used for Menstrual Hygiene Management (MHM). In contrast, awareness levels for tampons and menstrual cups are significantly lower, at 46% and 51% respectively. This suggests a need for increased education and awareness campaigns to 35  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) familiarize people with these products. While awareness about cotton pads is relatively high at 91%, it is still lower than sanitary napkins, indicating it as an alternative. Usage of various Products during Menstrual Cycle The data from the study population indicates Usage of various Products during Menstrual Cycle that sanitary napkins are overwhelmingly 75% the most used menstrual hygiene product, 53% with 75% of respondents utilizing them. In contrast, tampons and menstrual cups have exceptionally low usage rates at 3% and 4% 3% 4% 3% respectively. Cotton pads are used by 53% Sanitary Tempons Menstrual Cotton pad Others Napkin Cup of respondents. Sanitary napkins and cotton pads dominate the menstrual hygiene landscape in study population, with significantly higher usage compared to tampons, menstrual cups, and other unspecified products, emphasizing a strong preference for these two options. Mechanism of availing the Sanitary Napkins during Menstrual Cycle: Mechanism of availing the Sanitary Napkins during Menstrual Cycle 83% 100% 80% 60% 40% 5% 4% 4% 6% 20% 3% 0% ASHA Pick from Delivered Distributed Buy from Others distributes ASHA by ASHA @ at School Private in Common house home store meeting The data reveals that ASHA's sanitary napkin distribution methods (common meetings, ASHA's house, home delivery, and school distribution) reach a limited percentage of respondents (totaling 16% of the sample). In contrast, 83% of respondents obtain sanitary napkins from private stores, indicating commercial channels as the predominant source in the study population. Efforts are needed to enhance the accessibility and distribution network, particularly through 36  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) government health workers like ASHA, to broaden the accessibility of sanitary napkins to a larger population. Facilities for MHM at Home In a study population majority of respondents Facilities for MHM at home (83%) have access to changing facilities for 96% 100% sanitary napkins, and 88% have sufficient 95% 88% 87% water for menstrual hygiene management 90% 83% 85% (MHM). Additionally, 87% receive support 80% from family members for water access, and 75% 96% have privacy during MHM. These Changing Sufficient Support Privacy Facility Water from for Family findings indicate that there are robust Napkin members on water facilities and support systems in place for menstrual hygiene management in the study population, encompassing changing facilities, water access, family support, and privacy. Expenses on Sanitary Napkins per Month A significant portion of respondents in the EXPENSE on NAPKIN / MONTH study population, 37% spending less than Rs. 50, seem to have relatively low or no NILL expenditure on sanitary napkins. This could be > Rs.100 due to the use of subsidized or free sanitary Rs.50-Rs.100 napkins provided through government < Rs.50 schemes or other means. It is encouraging that 0% 10% 20% 30% 40% a substantial number of respondents viz 37% spend within the range of Rs. 50 to Rs. 100 per month, which suggests that sanitary napkins are affordable to a significant portion of the population. The 2% of respondents who spend more than Rs. 100 per month might be using premium or branded sanitary napkins, which could be more expensive. 8% of respondents did not provide information on their expenses 37  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Training on disposal of Sanitary Napkin Training on disposal of Sanitary Napkin A substantial 80% of respondents in the study population have received 20% No training on sanitary napkin disposal, indicating effective awareness 80% Yes initiatives. This indicates that a significant majority of respondents have been educated or trained on the proper disposal methods for sanitary napkins. This suggests active efforts, possibly from government programs or NGO, in educating people about proper disposal methods, emphasizing both hygiene and environmental sustainability. Mechanism of Disposal of Sanitary Napkins CInI's MHM program in the study Mechanism of Disposal of Sanitary Napkins population demonstrates considerable 70% success in promoting responsible 51% 54% sanitary napkin disposal methods. According to the data, 70% of 26% respondents opt for an eco-friendly Dustbin throgh Fire Matka Dig and approach by digging a hole for Paper wrap Insenator dispose disposal, ensuring safe burial of sanitary waste. Additionally, 54% use Matka incinerators, indicating successful implementation of this technology for sanitary napkin disposal. These methods reflect CInI's effectiveness in promoting environmentally conscious practices. While 51% of respondents use dustbins with paper wrap, indicating awareness and adherence to proper disposal techniques, 26% burn sanitary napkins, highlighting the need for further education on the environmental impact of this method. CInI could focus on encouraging more respondents to adopt safer disposal practices like using Matka incinerators. Overall, CInI's efforts have resulted in a significant portion of the population adopting eco- 38 friendly methods for sanitary napkin disposal, contributing to both hygiene and environmental sustainability in the region.  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) In conclusion, the successful implementation of Menstrual Hygiene Management (MHM) by CInI stands as a beacon of progress and empowerment. Through their dedicated efforts, CInI has not only addressed a basic biological need but has also broken barriers, shattered taboos, and paved the way for a more inclusive society. The impact of their initiatives reverberates far beyond the realm of menstrual hygiene by providing education, access to resources, and fostering a culture of understanding. CInI's commitment to MHM exemplifies the transformative power of grassroots initiatives. 39  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Chapter - 6 Health seeking Behaviour for Cervical Cancer Cervical cancer is a significant public health concern, and understanding the health-seeking behavior of individuals in Jharkhand is crucial for effective prevention, early detection, and management of this preventable disease. The state of Jharkhand faces unique challenges and opportunities in addressing cervical cancer and improving health-seeking behavior. Addressing cervical cancer in Jharkhand requires a multi-pronged approach that combines awareness campaigns, improved access to healthcare services, and the removal of social and cultural barriers. By focusing on health-seeking behavior and promoting early detection and prevention, Jharkhand can make significant strides in reducing the burden of cervical cancer and improving the overall health and well-being of its population. One of the primary challenges in Jharkhand is the lack of awareness about cervical cancer, its risk factors, symptoms, and preventive measures. Women in rural areas does not have much knowledge about the disease, leading to delayed or missed opportunities for early detection. In rural and remote areas of Jharkhand, access to healthcare facilities, especially for cervical cancer screening and treatment, remains limited. This hinders individuals from seeking timely medical attention. The accessibility of cervical cancer screening services in primary healthcare centers and rural areas are inadequate, leaving women with limited options for early detection. The given data will help us analyze the current scenario in Jharkhand and will help us focus on the opportunities to address the growing burden of cervical cancer. General Awareness and Knowledge about Cervical Cancer Overall, across the study population 65% of Knowledge about Cervical Cancer respondents have knowledge about cervical 70% 58% cancer. There are notable disparities in Dumka Hazaribaug knowledge about cervical cancer across 49% 85% E. Dumka various study population. East Singhbhum Singhbh… exhibits the highest awareness rate (85%), followed by Dumka (70%), Khunti (58%), and Hazaribaug (49%). 40  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) CInI's ongoing efforts should persist in educating and enlightening the population to enhance their understanding of cervical cancer, as well as its preventive measures and early detection methods. Elevating awareness remains a pivotal factor in diminishing both the occurrence and fatality rates linked to cervical cancer. Understanding about the Symptoms for Cervical Cancer Understanding about the Symptoms for CC Sympt Irreg Exce Post Bleedi Painful Blee Abnor Back Pain Fati Weig Pa Pain oms ular ss Menap ng Interco ding mal pain in gue ht in durin Blee blee ause after urse with disch Abdo reduc in g ding ding bleedi Sexual Foul arge main tion le urina in ng Interco smell with g tion MC urse blood Khunti 83% 67% 54% 75% 79% 83% 33% 25% 54% 38% 33% 54 75% % Hazari 64% 72% 59% 46% 41% 54% 33% 21% 44% 28% 26% 10 41% baug % E. 79% 72% 46% 64% 64% 74% 44% 46% 54% 69% 64% 38 54% Singhb % hum Dumk 67% 73% 17% 37% 33% 73% 47% 37% 63% 50% 53% 47 57% a % The data reveals a consistent pattern of understanding regarding cervical cancer symptoms in the respondents across the study population. "Irregular Bleeding" stands out as the most widely recognized symptom, reported prominently in all districts and indicating a significant level of cervical cancer awareness among respondents. Additionally, "Excess bleeding in menstrual cycle," "Abnormal discharge with blood," and "Bleeding after Sexual Intercourse" are commonly acknowledged symptoms across all districts. However, there is a variation in the reporting of less frequent symptoms such as "Pain during urination" and "Pain in leg," suggesting potential differences in awareness or symptom recognition among respondents. There might be a need for targeted awareness campaigns in specific districts, focusing on the less frequently reported symptoms, to ensure comprehensive knowledge among the residents. 41  GLOBAL BUSINESS SCHOOL & RESEARCH CENTRE Dr. D.Y. PATIL VIDYAPEETH, PUNE (Deemed to be University) Understanding regional variations in awareness can aid in tailoring educational programs effectively. Awareness about Risk Factors of Cervical Cancer Knowledge about Proportion RISK FACTORS of respondents for There are significant disparities in awareness for CC awareness about Risk Factors for about cervical cancer risk factors among the CC 44% 49% respondents of the study population. East 44% 49% Dumka Khunti Singhbhum stands out with the highest 51% awareness level, where 73% of respondents are 73% 51% 73% E. Hazaribaug knowledgeable about cervical cancer risk Singhbhum factors. Hazaribaug follows with a majority Khunti Hazaribaug E. Singhbhum Dumka (51%) of informed respondents. In contrast, Khunti and Dumka exhibit lower awareness rates, with only 49% and 44% of respondents, respectively, having knowledge about cervical cancer risk factors. These findings indicate varying levels of awareness and highlight the need for targeted awareness campaigns in specific districts with lower awareness to improve knowledge about cervical cancer risk factors. Understanding about the Risk Factor for Cervical Cancer Understanding about the Risk Factors of CC 100% 90% 80% 70% 60