Spreading the canvas

There is no shortage of things to say about what’s wrong with India’s health sector. There’s no shortage of silver linings here, either. One such instance is a potentially transformative cancer care initiative that is at once singular and inclusive, comprehensive and strikingly effective.

In the works since 2017 and now at various stages of rollout in Assam, Andhra Pradesh, Jharkhand, Karnataka, Maharashtra, Odisha and Uttar Pradesh, the cancer care programme of the Tata Trusts is built on four pillars: accessibility; high-quality treatment; affordability; and awareness, early detection and palliative care. Put it all together and you have the ‘distributed model of cancer care’.

Sadum Veenavati, a 35-year-old from Kongavaripalli village in the Tirupati district of Andhra Pradesh, does not understand the details of the programme, but here she is at a mobile screening camp that is part of it. “The head of our village told me about this camp and I wanted to get screened,” says the mother of two. “I thought it best to have this done because my mother died of cancer. I went through the three tests and I’ve come out clean.”

The three screenings are for oral, cervical and breast cancer, the most common manifestations of the disease in India. Ms Veenavathi was keen to take the tests but, unlike her, many people in small towns and rural reaches are disinclined to. “There is fear and then there’s the stigma of cancer,” explains Hemant Kumar, a district programme manager with what is known as the catchment outreach programme.

Specific nursing skills

The initiative is part of the awareness and screening efforts of the Sri Venkateswara Institute of Cancer Care & Advanced Research (SVICCAR), the cancer facility in Tirupati that became fully operational in May 2022. Mobilising villagers and organising the camp is Mr Kumar’s responsibility and there is plenty that goes into it.

“We start with a recce of the village and we meet the key influencers there,” says Mr Kumar. “We also coordinate with the local government health workers. At the camp itself, we don’t screen just for cancers; we also check blood pressure, sugar levels and for hepatitis B and C. We don’t call it a cancer-screening camp, because that could mean fewer people showing up for testing.”

The awareness component is crucial in the mix. “We gather groups of about 30 people and explain the tests we do and we talk about tobacco use and its risks, about oral, breast and cervical cancers,” adds Mr Kumar. “We go through women’s self-help groups and we to go to schools and colleges. All this motivating and mobilising is to drive home the message of cancer awareness.”

At the heart of the distributed model is accessibility, the objective being to bring cancer care closer to where patients live. A step-down framework and human resource development are the essentials here. The step-down structure operates at four levels, from apex centres with the entire range of cancer-care services and equipment to outreach initiatives that include community awareness events and screening.

In human resources development, the endeavour is to create a cadre of top-notch professionals that will ensure the success of the distributed care model. These professionals are recruited from medical and nursing colleges, referral networks and recruitment portals. Oncology fellowships and certificate programmes are also part of the mix, as are cross-skilling and up-skilling initiatives.

In affordable care, the distributed model concentrates on connecting patients to various state and central government health insurance schemes. Additionally, the National Cancer Grid, a network of cancer centres, research institutes, patient groups and charitable institutions, lends a hand and provides guidance.

Quality of care is a given in the programme, while the prevention, detection and palliative care part works to reduce the cancer burden through a slew of measures, from screening to diagnosis and treatment. Kiosks at government hospitals and mobile medical units — to reach people in the interiors — add muscle to the awareness and screening agenda.

With more than 1.4 million reported cancer cases a year and countless ones that remain unreported, there is no understating the reality that India is confronted by a cancer crisis of gargantuan proportions. The value and potential of the distributed care model — to aid governmental efforts and protect a wider spread of the populace — is clear in the circumstances.

“We began with this utopian dream in Assam and we figured that if we could pull it off there, we had a shot at replicating the [distributed care] model across India,” says Sanjiv Chopra, who helms the Tata Trusts cancer care programme. “Gap interventions is what we do and our primary goal is to improve awareness about cancer and early diagnosis.”

The expertise and the experience that the Trusts have acquired over the course of the cancer care journey give the distributed care model a chance of succeeding on a greater scale. The rationale for it is solid. “Most of the cancer hospitals in the country are in big urban centres, but as far as towns and villages are concerned, cancer care facilities are almost non-existent,” says Dr Chopra. 

The expectation is that the distributed care model can make a difference where it counts, in accessibility, affordability, treatment and awareness, but realising its promise will take much more than just the Tata Trusts. That explains the need for collaboration and a coming together with the central and state governments, public and private corporations, philanthropies, NGOs and medical institutions.

There is no better partner than the government, for sure, and Dr Chopra emphasises the criticality of this. “Many states have listened to us and local government functionaries have been very helpful, supporting us with much-required assistance to set up tertiary cancer care centres and cancer institutes,” he says. “We also have like-minded organisations and companies joining us. We could not have expanded the way we have without such backing.”

Ground realities

What happens on the ground is, in the final reckoning, what matters most. “I’m thankful for the treatment I’m getting and for being able to live a longer life,” says B Sampoornamma, a 76-year-old villager from Satturabailu in Tirupati district who was diagnosed with breast cancer eight months back. Ms Sampoornamma’s cancer was detected following a chance visit to the kiosk run by personnel from SVICCAR at a nearby community health centre.

This was another instance of the distributed care model percolating to a person who would otherwise have fallen through the cancer crack. And it is in helping people like Ms Sampoornamma that the worth of the Tata Trusts’ cancer care programme shines brightest.