The challenge faced by the cancer patient is access to care and for the health system, thenon-availability of qualified personnel. Besides financial issues, patients face challenges of finding a cancer center. Governments are keen to offer universal health coverage but are in need of sustainable systems. A novel healthcare delivery system was designed and has been operational in several states of India.
General duty medical officers and nurses from government district hospitals were trained in oncology for one month. Various administrative reforms, restructuring and techno-mentoring (constant, 24x7, mentorship using WhatsAppR, Telephonic communication, regular continuing medical education) were used to create a system of health care delivery in oncology. The drug distribution system was changed to include essential oncology drugs.
A district cancer care programme has been initiated in six states of India, involving 157 hospitals constituting about 20 % of the nation. The hospital has a nodal cancer unit, with nodal cancer officer and nurse in charge to deliver cancer services, such as counselling at all stages of care, assistance in diagnostics, (which may vary from biopsy to scan to tumor markers), follow up care, palliative care, end of life care and, most importantly, chemotherapy. A patient from the district has a choice of conitnuum of care at local hospital to which he is used. He can visit more frequently with no cost involved. This system change and empowerment has allowed the government to bring care closer to the facility and help patients gain access. A satisfaction survey done amongst patients shows there is a strong willingness to follow in districts.This is saving thousand of families from impoverishment. The creation of a system of cancer care delivery has led to other states following this example. From one state it has gone to six states,(population coverage of around 300 million).
Primary care physicians can be effectively empowered to offer specialised cancer care in government-run facilities. This duplicable, sustainable model (Pendharkar model) using existing human resources can be used by many countries fighting with shortages of personnel and access issues.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
The author has declared no conflicts of interest.