Background: Community-based screening is essential for early cancer detection. Under India's Ayushman Bharat Digital Mission (ABDM), the National NCD Portal enables real-time data recording and reporting by frontline workers for breast, oral, and cervical cancer screening.

Objective: To identify barriers and facilitators to adopting the digital interventions for population based NCD screening, and to examine how governance, workforce capacity, and system design influence data quality, reporting, and programme performance.

Methods: A mixed-methods implementation research study using CFIR Framework was conducted in government health facilities in Kamrup District, Assam. Data sources included National NCD Portal Dashboard records, facility-level data, operational guidelines review, key informant interviews (with programme managers, frontline workers, and technical support staff), and  field observations of Community-Based Assessment  Checklist (CBAC) scoring, mobile/web portal workflows, and time-motion mapping. Thematic analysis of qualitative data; descriptive analysis of the quantitative programme data for system usage and data completeness. 

Results: Key facilitators included strong political commitment and positive provider attitudes toward health technologies. Major barriers were inadequate trained manpower and poor screening infrastructure, technological issues particularly for cervical cancer and breast cancer screening. Support for cancer screening is mostly through mobile clinics in rural areas. Cultural issues are also posing a barrier in accessing cancer care. NCD Portal data showed enrollment of 4,54,493 (69%) and 420,596 (63%) individuals aged ≥30 years screened via CBAC, but frontline workers frequently skipped cancer-specific screening, focusing only on risk scoring for Hypertension and Diabetes. This points out that the frontline workers are comfortable with a screening tool that helps in making referral decisions. ABHA-ID creation reached ~68%, with overall data entry poorly maintained and incomplete. 

Conclusion: The NP-NCD digital initiative represents a missed opportunity due to symbolic rather than strategic digitization. Enhanced planning, workforce training, infrastructure investment, and system improvements are needed to scale up cancer screening, enable early diagnosis and treatment, and ultimately improve survival rates. Capacity-building training and specialist support, inclusion of point-of-care devices in outreach camps were planned to bridge the systemic gaps.
?Dr Purabi Phukan is a Professor, Department of Community and Family Medicine, All India Institute of Medical Science, Guwahati, Assam, India. She completed her MBBS and MD from Guwahati Medical College and Hospital, Assam. Additionally she has a Fellowship in Family Medicine and FAIMER. Before joining AIIMS, Guwahati she was Professor and Head, Department of Community Medicine, ESIC Medical College, Alwar, Rajasthan. She has more than 10 years of academic and administrative experience in undergraduate and postgraduate teaching. She was involved as Nodal officer for several programme implementations like disease surveillance, TB support services, resource person for training medical officers on cancer screening, school health services,tribal health. She has authored more than 10 peer reviewed publications and authored book chapters on ocular health and family planning.  She is currently working as Principal Investigator and Co-PI for extramural ICMR funded projects on NCD care and TB. 
 

Population screening and cascade care data NCD portal Dashboard