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Paper short abstract

Sexual and reproductive health (SRH) gaps in rural India shape unequal cervical cancer outcomes. This paper examines how CAPED’s hub-and-spoke model addresses demand and supply barriers by strengthening PHCs and enabling collaboration between NGOs, ASHAs, and state health systems.

Paper long abstract

Sexual and reproductive health (SRH) interventions in the global South have long been shaped by vertical programming and top-down biomedical approaches. This is visible in cervical cancer prevention, which remains a major SRH challenge in India, especially in rural and underserved regions. Weak primary health care infrastructure, limited human resources, and fragmented referral pathways contribute to late diagnosis and poor outcomes. Addressing these gaps requires moving beyond hospital-centric models towards approaches that strengthen local health systems and build community trust.

This paper examines how the Cancer Awareness, Prevention and Early Detection (CAPED) initiative operationalises a decentralised hub-and-spoke model to address both demand and supply-side constraints in cervical cancer prevention. Drawing on implementation experience across multiple Indian states, the paper analyses collaborative relationships between non-governmental organisations, ASHAs, frontline health workers, and state and district health departments.

On the demand side, ASHAs with NGOs play a critical role in awareness-building, pre-screening counselling, stigma reduction, and patient navigation, particularly among women with limited access to information and services. On the supply side, CAPED strengthens rural primary health centres by supporting workforce training, infrastructure readiness, deployment of appropriate screening technologies, and structured referral linkages to higher levels of care.

The hub facilitates coordination, data-driven monitoring, and adaptive problem-solving, while the spokes, PHCs and community platforms, ensure local ownership and responsiveness. This enhances trust, improves continuity of care, and embeds cervical cancer prevention within routine SRH services showing how NGOs and CHWs can work with public systems to strengthen reproductive health outcomes in low-resource settings.