June 2021 | 996 words | 4-minute read
India faces a huge cancer burden — one in ten Indians will develop cancer, and one in fifteen will die of it. Every year, over 1.4 million new cases are reported in the country — most of them in later stages, leading to high morbidity and mortality rates.
Factors that aggravate the situation include:
- A shortfall of infrastructure and skilled manpower to treat the disease.
- The facilities that do exist are concentrated in urban areas.
- Low insurance coverage and high out-of-pocket expenses contribute to high drop-out rates during treatment.
- Unhealthy lifestyles and lack of awareness contribute to an increased risk.
Affordable and high-quality healthcare for Indians is a primary focus of the Tata Trusts, and one of the ways this is operationalised is an initiative to transform cancer care. The Cancer Care programme partners with state governments and like-minded organisations to develop a network of healthcare facilities to treat common cancers. The backbone of the programme is a ‘distributed model of cancer care’ that comprises of four pillars:
- Enhanced access
- Uniform high-quality care
- Affordable care
- Awareness, early detection and palliative care
This focuses on building a network of healthcare facilities closer to people’s homes so that they don’t have to travel long distances for diagnostic and treatment facilities. A step-down model and human resource development form the key components.
The step-down model has four levels:
Level 1: Apex centres that are equipped with an array of oncology services including radiation, medicine, surgery, nuclear medicine and allied facilities. The Mahamana Pandit Madan Mohan Malaviya Cancer Centre at Varanasi (Uttar Pradesh), jointly set up by the Tata Trusts, the Tata Memorial Centre (TMC) and Banaras Hindu University, is the first apex centre under the model. Another centre is being upgraded at the State Cancer Institute in Guwahati (Assam).
Level 2: Hospitals with comprehensive oncology services and allied facilities, some of which are linked to the government medical college hospitals. The Tata Trusts have facilitated an upgradation in the capacity of two such facilities — the Indian Railway Cancer Institute and Research Centre at Varanasi (Uttar Pradesh) and the Meherbai Tata Memorial Hospital in Jamshedpur (Jharkhand).
Seven green field centres are underway in Barpeta, Silchar, Diphu, Dibrugarh (all in Assam) Chandrapur (Maharashtra), Tirupati (Andhra Pradesh) and Ranchi (Jharkhand). Special Purpose Vehicles (SPVs) have been set up to run these facilities.
Level 3: Diagnostic and daycare radiotherapy and chemotherapy units. Five such units in Assam will be managed by the SPVs, and the capacities of two existing units at Cachar (Assam) and Mangalore (Karnataka) are being enhanced. Ad-hoc daycare chemotherapy centres have also been set up in Tirupati, Dibrugarh, Diphu and Barpeta, which offer chemotherapy, consultation and diagnostic facilities to patients.
Level 4: Outreach initiatives, including palliative care. Opportunistic screening kiosks have been proactively introduced to down-stage cancer. Health Screening and Awareness Centres, also known as Swasth Kiosks, are being set up in collaboration with government medical college hospitals and district hospitals. These provide a general checkup (including screening for oral, breast and cervical cancers) and target family members and relatives who accompany the patients.
Swasth Kiosks have been set up in Guwahati, Barpeta, Tezpur, Dibrugarh, Diphu, Chandrapur, Ranchi and Tirupati. It is expected that these measures will help down-stage cancer and improve the early-to-late detection ratio from 30:70 to 70:30.
Uniform high-quality care
NCG guidelines and pathways are being adopted across the centres to enable successful implementation of the distributed model of cancer care. A central command centre is also being envisaged, which will link all centres and provide services such as virtual consultations, remote radiology and pathology reporting, a virtual tumour board, inter alia.
The Tata Trusts have lent their support to the development of uniform standards of care in the treatment of cancer, which encompass empanelment with government schemes, policy advocacy for insurance coverage of procedures, and group negotiation to procure drugs and equipment. The Trusts also support the operationalisation of the National Cancer Grid (NCG), a network of 140 cancer centres, research institutions, patient groups and charitable organisations.
Awareness, early detection and palliative care
The focus on reducing the cancer burden includes awareness programmes on the causes of cancer and its prevention, screening, diagnosis and treatment. The Trusts’ team works with the National Health Mission for smooth execution of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes in institutions that are part of the step-down model. In addition, close to 5,000 frontline health workers have been trained for screening of non-communicable diseases (NCDs) and for community outreach — the impact of these activities are discernible in the box below.
The innovative distributed model of cancer care
Geography: Assam, Andhra Pradesh, Jharkhand, Maharashtra and Odisha
Spend: Rs. 1,732.04 crore (cumulative for FY19 and FY20)
- Currently 9 ‘Opportunistic Screening Kiosks’ across India, with more in the pipeline
- Over 3,800 patients availed OPD consultations across the 4 palliative care centres
- Over 3,000 OPD consultations and over 1,200 Chemo sessions have been held at the 4 Day Care Chemotherapy Centres.
- Over 9,500 frontline healthcare providers have been trained for screening of NCDs and implementation of community outreach.
- Over 90,000 people have been screened for NCDs through the community outreach programmes.
- Over 1 lakh people have been sensitised and trained on tobacco control initiatives and the harmful effects of tobacco.
- Over 8,900 people have been reached out through tobacco tele-counselling.
Source: Touching Lives by Tata Sustainability Group