"You have cancer."
These terrifying words resonate in the ears of someone diagnosed with the dreaded disease. And for their family, the first thoughts are about the affordability of the treatment. In a low-resource country like India, it is one of the most catastrophic Non-Communicable Diseases (NCD) today. The numbers are damning: 12.5 lakh new cases are diagnosed every year and around 28 lakh cases of cancers are prevalent at any given point of time. It also claims lives of about 6.8 lakh patients per year. According to the World Health Organization (WHO), death from cancer in India is projected to rise to 13.1 million by the year 2030.
This is precisely why there is an urgent need for a comprehensive approach to improve access to quality cancer care, and to persistently work at developing robust healthcare infrastructure and surveillance to tame the havoc this disease brings in its wake.
According to the UN and WHO, the burden of NCDs might cost India US$ 6.2 trillion during the period 2012-2030. And cancer is a big chunk of this.
Access to care is a multidimensional concept and involves timely use and delivery of affordable personal health services to achieve the best possible health outcomes. Obtaining access to related medical services is complex and the process involves multiple interactions with healthcare providers. They, in turn, are stressed due to the constrained healthcare structures and environments that besiege the country today. Which is why both—accessing as well as providing cancer care—are posing insurmountable challenges.
The challenge is huge
Delivery of affordable and equitable cancer care is one of India's biggest public health challenges. Public expenditure on cancer in India remains below US$10 per person and overall public expenditure on health care is still marginally above 1% of GDP. As per WHO World Health Statistics 2015, India spent 1.16% of public expenditure on health as a percentage of GDP, ranking 187th among 194 countries. Global evidence on health spending shows that unless a country spends at least 5-6% of its GDP on health, with a major part of it coming from the government, basic healthcare needs are seldom met.
Out-of-pocket expenses are another big threat to patients and families, and a cancer diagnosis sounds like a death knell! According to India's draft National Health Policy 2015 the country's OoP expenditure for health sitting at 60% is one of the highest in the world and 55 million Indians fell into serious poverty because of their healthcare spending during 2011-12. Add to this the fact that about 47% and 31% of medical services in rural and urban India were paid through assistance from banks, consequently pushing over 60 million people into poverty. It's a fact that poverty is a significant risk factor for contracting NCDs, and these diseases in turn can quickly exacerbate personal financial crises. And cancer treatments are increasingly responsible for enormous expenditures negatively affecting the patient and their family.
Way forward
Partnership to Fight Chronic Disease (PFCD), a not-for-profit committed to raising awareness and finding sustainable solutions to address chronic diseases, has been working in this field for many years now and understands that we are entering a new era of cancer care with many new challenges. The government needs to understand the changing disease profile and allocate more funds to NCD's. Ideally India's allocation on NCD programs should be doubled by 2020 and tripled by 2025. And cancer needs to get a huge piece of the pie. Otherwise the damage is expected to be huge, as, according to the UN and WHO, the burden of NCDs might cost India US$ 6.2 trillion during the period 2012-2030. And cancer is a big chunk of this.
Ideally India's allocation on NCD programs should be doubled by 2020 and tripled by 2025. And cancer needs to get a huge piece of the pie.
It's now time to develop a holistic cancer policy for the country—a comprehensive cancer control program that estimates the cancer burden, formulates policies to ensure better prevention, and helps those already suffering from it get access to quality care and treatment. It is imperative to set up national goals by tracking the financial burden of cancer and to strategise health policies accordingly, with a clear aim to help ease the burden on the patient group. To this effect, the fact that Government of India has approved the proposal for setting up the National Cancer Institute (NCI) under the All India Institute of Medical Sciences at Jhajjar, Haryana is a good sign. It has the potential to work as a nodal centre for India-centric cancer research, promotive, preventive and curative aspects of care and human resource development.
To this effect SANKALP—a national blueprint released last year by PFCD in India—had recommended several measures, out of which some have already been initiated by the government. But more needs to be done. Simple steps like strengthening the tertiary tier, developing the local health system to be able to screen the maximum number of people, providing extensive diagnostics and free essential drugs, offering disease specific insurance schemes, providing coverage even to those in unorganised sectors, using CSR to strengthen the healthcare and switching focus from patient care to preventive care, will all go a long way.
