Feature story

A share of care

Spread over three districts, the Jharkhand cancer care programme enables awareness, screening, diagnosis and treatment for a largely rural populace

Once ignorant of it, Theblu Munda now has more than an inkling of what the beast is about. “I’m aware of the signs and symptoms of cancer, I understand the importance of early detection and screening, the risk factors involved and whom to reach out to at any sign of concern,” says the 63-year-old labourer from Ajaigarh village in Jharkhand’s Ranchi district.

Lalitha Kartik, a 48-year-old housewife who lives in the Lowadih locality of Ranchi city, had access to the same screening as Mr Munda. “The tests we had at the camp, these should be done from time to time because they are so crucial,” she says. “Those with cancer in our area do get treated but they are mostly unaware of cancer-care facilities. They do now.”

Mr Munda and Ms Kartik are two among 63,000-plus people who have been screened for three common cancers — oral, breast and cervical — as well as for diabetes and hypertension under a community-centred public health programme initiated in Ranchi district in February 2020 by the Ranchi Cancer Care Foundation (RCCF).

RCCF is part of the larger Tata Cancer Care Foundation (TCCF), which has been hard at work helping the central government and the state governments of Assam, Andhra Pradesh, Jharkhand, Karnataka, Maharashtra, Odisha and Uttar Pradesh in tackling what is a clear and present danger (more than 800,000 Indians are estimated to have died of cancer-related causes in 2022).

Screening for oral cancer in Kujram village in Khunti district of Jharkhand

The centrepiece of the Tata Trusts’ wider cancer programme is the ‘distributed model of care’, which comprises accessibility; high-quality treatment; affordability; and awareness, early detection and palliative care. The model has flowered most extensively in Assam, where it is spread over eight districts and includes a network of cancer hospitals, day-care centres for diagnosis and treatment and a strong public health team for screening and awareness. The effort in Jharkhand is directed at, in time, replicating the Assam archetype.

The community is at the centre in the Jharkhand cancer care initiative, a collaborative endeavour involving the state government and the central government’s National Health Mission. Screening, early detection and awareness drives — targeted principally at villagers and students — are of paramount importance in the programme. Diagnosis and treatment and training modules for frontline health workers, community health officers and doctors are also part of the initiative.

Currently operational in the districts of Ranchi, Seraikela Kharsawan and Khunti, the programme depends on partnerships with Jharkhand’s health and education departments and with a spectrum of non-governmental stakeholders, among them philanthropies, self-help groups, private general practitioners and civil society as a whole.

A community awareness session in Hesadih village in Ranchi district

Shift in approach

Given that the going hasn’t exactly been easy for the RCCF team, the progress made has been substantial. Some of that is down to changing tack when the ground situation so demanded, as it did in the aftermath of the Covid pandemic. “We shifted our approach from conducting screening camps only at [the state’s] health and wellness centres to making it a hybrid model wherein we went village by village,” says Nilesh Kumar, the district programmer with RCCF.

Bringing frontline health workers, community health officers and others in the state’s official setup into the programme fold was vital. “Their support helped in organising the screening camps and increasing the attendance of villagers,” adds Mr Kumar. “As for the community, they were receptive whenever we said the camp was for diabetes and hypertension; not so much if they came to know cancer screening was being done. That’s why we started emphasising that these were general health checkup camps.”

For those suspected of having the disease, time is of the essence in treatment. “We start follow-ups immediately and we have ‘patient navigators’ to guide the affected to hospitals for confirmatory diagnosis and treatment,” says Mr Kumar. 

The programme depends on three institutions for the treatment of patients: the Ranchi Cancer Hospital and Research Centre (RCHRC), an 82-bed facility established by RCCF and TCCF with support from the Tata Trusts, the government-owned Rajendra Institute of Medical Sciences (also in Ranchi) and the Meherbai Tata Memorial Hospital, Jamshedpur (this is managed by Tata Steel).

RCHRC, which threw open its welcome facilities in May 2023, is the programme’s own, offering a range of cancer treatments, from chemotherapy and radiotherapy to surgical oncology. Affordability and quality of care are the hallmarks of the Centre, where charges for the poor are heavily subsidised.

The cost of diagnosis and treatment is often the biggest barrier to getting better for those suffering from cancer. The programme’s exertions to cover the gap, mainly by linking patients to government health and insurance schemes, are a work in progress. “It’s a challenge we are constantly faced with,” says Mr Kumar, “and counselling by our patient navigators is critical in the context.”

There’s no doubting the contribution of the programme in aiding Jharkhand to cope with its cancer burden. “We have done well on the awareness front,” says Mr Kumar. “Second, we have shown what quality screening is and how this can be done at the village level. And third, we have had a fairly forceful impact on the frontline workers involved in the initiative.”

Community health workers (right) from Duli village in Khunti district being instructed about the documentation process for screening

Problems aplenty

Anita Devi, a government community health worker in Ranchi, is realistic about the difficulties cancer patients have to deal with. “Proper facilities are not available in rural areas,” she says. “Suspected cases are referred to the Ranchi centres but most poor patients are disinclined to travel that far for a variety of reasons. For many of these patients, their livelihood matters more than their health.”

The training modules for frontline workers, community health officers and others are an essential feature of the initiative. These sessions, conducted in various villages in collaboration with the National Health Mission and district health authorities, have proven more than useful in providing an education on cancer to more than 2,400 health personnel working in rural reaches.

The Jharkhand cancer care programme began with nine staffers and the number has grown to 40. There are nine screening teams to conduct the camps: six in Ranchi, two in Seraikela Kharsawan and one in Khunti. These teams have their hands full and the going will get more intense in the years ahead.

“Help for patients with diagnostics, advocacy with the government and connecting the community to treatment centres — all of these have to be pushed,” says Mr Kumar. “And we hope to see the state government taking ownership of the programme.”

“We have had to overcome quite a few challenges to come this far with the programme,” says Paul Sebastian, head, public health programme with TCCF. “Jharkhand is a big state and, once you leave the main cities, very rural. That makes things tricky. We have dealt with deficiencies of consumables, lack of privacy at screening sites and the like.”

Dr Sebastian adds that the intent of the programme is to cover 15% of those in the 30-65 age bracket. “The state government is keen that our engagement is taken to a next level, which means covering other districts. We don’t have the bandwidth to do that as of now, so we are planning to propose a technical partnership to help train frontline health workers in all of the state’s districts.”

The learning from the Jharkhand initiative and others like it has informed the Tata Trusts’ evolving approach in cancer care. “We have come to understand that this cannot be a plug-and-play model,” explains Dr Sebastian. “It needs to be tailored to a particular geography to suit the local culture and local requirements. I'm sure that we’ll do even better going forward.”