Kerala Cancer Control Strategy 2018–30: a pragmatic vision of equitable, accessible, and affordable cancer care in low-resource settings

Abstract

The Indian state of Kerala has achieved remarkable success in communicable disease prevention and in maternal and child health. Over the past 30-40 years, non-communicable diseases, such as cancer, have emerged as new public health challenges. The Kerala Cancer Control Strategy provides a roadmap to address the various cancer-related challenges in a timely manner. The goals and targets set in the document will complement larger efforts to meet sustainable development goals. A State Cancer Control Board was formed, with the Minister for Health of the Government of Kerala as the chairperson and representation by administrators and oncologists from both private and public institutions. District cancer control committees are being formed in all 14 districts of Kerala under the head of district administration and with the involvement of public representatives, civil society, medical professional associations, and health-care administrators. The committees will monitor and implement the cancer control strategy. The main objective of decentralising the approach by having District Cancer Control Committees is to promote early diagnosis and ensure a treatment-care continuum. It will focus not only on current cases but also take preventive measures at the individual and societal levels, and engage the Panchayathi Raj Institutions (local self-government) to take various measures to reduce the cancer burden in the state. The Kerala Cancer Care Grid is being formed to ensure equitable access to affordable cancer detection and treatment services within 50 km of the residence of patients. This grid is envisaged as a network of different tiers of public health institutions with assistance from private health facilities. Defined responsibilities in cancer awareness, public education, early cancer detection, referral pathway, appropriate management, rehabilitation, and patient follow-up form the core of function of the Kerala Cancer Care Grid, which will ensure that standard treatment protocols are used and that costs are contained. Integrated prevention and control of cancer risk factors through citizen participation and policy support will be implemented through the District Cancer Control Committee. The Kerala Cancer Control Strategy is in the initial implementation stage. District Cancer Control Committees act as a platform for partnership with private hospitals and civil society organisations. A District Cancer Control Programme was piloted in one district and is being extended to two more districts in 2022. The programme is expected to be extended to all districts in Kerala by the end of 2022. Decentralisation of cancer care has begun with district hospitals and sub-district hospitals to provide cancer chemotherapy services. Workshops were done to bring out uniform information, education, and communication materials and treatment protocols. To streamline cancer documentation and assess cancer burden, a state cancer registry is being implemented, which would also provide longitudinal details and survival data. The Kerala Cancer Control Strategy envisages a state-wide uniform strategy for cancer control. Decentralisation of cancer care will reduce the workload of apex cancer centres, freeing resources for those with greater needs. The Kerala Cancer Care Grid has the potential to revolutionise the delivery of cancer care in the state. Other low-resource countries could adapt this model to provide optimum cancer care for their population. None.