Cancer care for the poor-health system augmentation model.

Abstract

e13514 Background: Access to cancer care is well recognized issue. It has many elements, mainly- social inequity, financial, distance to care centers, health behavior etc. These challenges increase with the level of poverty in LMIC. Models of peripheral empowerment, cost reduction, creation of alternate workforce, bending of health systems to include cancer care as a stream are important. Here we report incorporation of cancer vertical in to existing health care delivery models of India (Pendharkar model). Methods: Health care to major population is provided through government lead systems of primary health care centers, merging at district administrative level in to district hospitals. As per various WHO mandates the focus had been on general medicine, surgery, maternal and child health. Through advocacy a parallel vertical of cancer care delivery was initiated, creating “district cancer program” with written down organizational, functional and financial structure. Starting from one state it was expanded to many states. Results: Initiation and launch of district cancer care program has revolutionized cancer care at state level. One medical officer was designated as district cancer nodal officer. He was trained and given physical identity with creation of cancer unit with patient beds, and capacity of performing procedures including chemotherapy. Paramedical personnel and nurses were attached to this unit and trained. Drug formulary of the state was changed with addition of anticancer drugs in to the list. Procurement process at state level was started and units were equipped with anticancer drug bank. Cancer officers were mandated to play various roles like-assist in cancer patients’ journey- from diagnostics to end of life care offering free chemotherapy and palliative care, creating registry, public awareness and professional awareness, assisting in cancer screening programs. The program completing 8 years, has been initiated in 8 states, with nearly 200 districts trained. Five states have formalized it by state notifications issuing operational guidelines with pan state coverage, as a vertical program. Few hundred patients are helped on daily basis. Conclusions: Reduction in cancer care gap can be achieved using existing widespread government health system, by creating vertical cancer program in existing structure. It can be facilitated by utilizing existing resources, capacity building of alternate oncology workforce, mandating health system to take care of cancer patients at affordable cost. [Table: see text]