Policy Update
Arjun Brij
INTRODUCTION
Cancer is a major health problem in India, affecting more people over the years. This disease not only impacts patients and their families but also strains hospitals, particularly in smaller towns and villages that lack specialized care. The Indian Council of Medical Research predicted that more than 1.5 million new cancer cases would arise in 2024, with numbers expected to rise further due to factors like changing lifestyles, an aging population, pollution, and increased tobacco use.
In response, the Indian Government plans to set up Daycare Cancer Centres (DCCCs) in all district hospitals within three years. This initiative aims to decentralize cancer treatment, making it easier for people to access care near their homes. It aligns with the goals of universal health coverage and the National Health Policy 2017, as well as The Ayushman Bharat scheme.
There are two main reasons for DCCCs. First, cancer treatment often requires visits to major hospitals in cities, which is burdensome for rural patients who face long trips and high costs. By bringing cancer services to district levels, the government aims to reduce travel difficulties and expenses.
Second, urban cancer centers are overcrowded, leading to long wait times that can delay urgent treatments. Distributing cancer care through DCCCs can reduce the pressure on city hospitals, allowing quicker treatment initiation. Early diagnosis and intervention are crucial in cancer care, and having local services can improve these outcomes.
CHALLENGES
Implementing DCCCs supports the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS). Yet, several challenges must be addressed, including infrastructural, financial, logistical, technological, and social hurdles.
1. Infrastructural Readiness
Many district hospitals are not equipped for cancer care. Issues include lack of space, outdated facilities, poor sanitation, inadequate cold storage for chemotherapy drugs, and unreliable power supply. Upgrading these facilities may take significant time and money.
2. Inadequate Trained Human Resources
There is a shortage of cancer specialists, such as medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses. India has less than 2,000 medical oncologists for over 1.4 billion people, and few work in rural areas due to insufficient facilities and opportunities.
District-level doctors and staff often lack training in cancer care, especially for chemotherapy and palliative care. It takes time, funding, and institutional support to provide the necessary training.
3. Equipment and Medical Supplies
Diagnosing and treating cancer requires equipment like CT scanners, MRI machines, biopsy tools, infusion pumps, and pathology labs. Most district hospitals do not have these, and acquiring them can be slow and complicated. Maintenance and a continuous supply of cancer medicines, which require careful storage, also present challenges.
4. Integration with Tertiary Centers
DCCCs should be part of a larger cancer care network. Effective referral systems to specialized centers for complex or advanced cases are needed. Currently, referral processes between district hospitals and major cancer centers are weak and informal, often depending on personal contacts instead of established protocols.
Additionally, patient details and medical history need to be easily moved between healthcare institutions. Without a digital health system to link these, it can lead to delays, repeated tests, and inadequate patient care.
5. Challenges in Digital Access and Tele-oncology
Telemedicine offers an exciting way for doctors to consult with distant patients and share medical expertise. Yet, the lack of internet access, adequate bandwidth, and a stable power supply in many areas hinders such services. This affects the use of tele-oncology—technology-based cancer care.
Moreover, both patients and healthcare providers often have varying levels of understanding of digital health tools. Better infrastructure and training are essential to make these tools user-friendly.
6. Financial and Administrative Challenges
Although the government has devoted Rs 3,200 crore to this project, the true costs might be higher. Staffing, availability of medicines, and building efforts could be affected. If funds are delayed or administrative issues arise, further delays can occur.
Collaboration across departments, such as health, finance, infrastructure, and IT, is vital. Without this coordination, efforts may become scattered and less effective.
7. Ensuring Quality Care
Consistent treatment protocols are essential for maintaining quality care in District Cancer Care Centers (DCCCs). Without strict adherence to clinical guidelines and regular checks, treatment can vary. Systems for quality assurance and external assessments are necessary.
8. Palliative and Psychosocial Care Challenges
Cancer treatment involves more than just physical care. Mental health support and pain management are equally important. Yet, counseling services and support groups are scarce in district hospitals, and stigma around cancer prevents many patients from seeking mental health help. These services should be integrated into DCCCs, and staff should be trained in communication and counseling.
9. Insurance Issues and Claim Delays
Despite plans to include DCCCs in insurance schemes like PMJAY, delays in reimbursements are common in district hospitals. This affects their cash flow and limits access to essential medicines and services. Simplifying the claims process and reducing paperwork is necessary.
10. Overcoming Community Stigma
Cancer remains a taboo topic, particularly in rural areas, despite greater awareness. Cultural beliefs and fear discourage individuals from attending screening camps and seeking early diagnosis. Misunderstandings about chemotherapy make matters worse. Intensive community engagement and behavior-change campaigns are needed to tackle these issues.
WAY FORWARD
1. Investment in Infrastructure
According to existing gap analyses, a special corpus should be provided to quickly upgrade district hospitals. Turnkey project schemes where government and private company participation are involved can help speed up the construction and installation of equipment. Standardized designs and equipment must be available to ensure uniformity and quality control.
2. Human Resource Development
Short fellowships, rotation postings, and formal training in oncology can be organized for district hospital personnel. Nursing courses can include cancer care modules and non-monetary incentives such as hardship allowances to entice specialists to serve in backward areas.
3. Technological Integration
A national digital cancer registry, interoperable EMRs, and real-time teleconsultation platforms need to be developed. Partnerships with technology firms can ensure user-friendly interfaces and back-end support. Solar-powered digital kiosks in remote areas can serve as access points for telemedicine.
4. Policy and Governance Reforms
Unambiguous operational guidelines, monitoring dashboards, and district-level decentralized decision-making powers will be more accountable. A nodal agency at the center can conduct implementation, training, procurement, and audit functions.
5. Community Engagement and IEC
Wellness centers and Accredited Social Health Activists (ASHAs) can be trained to spread awareness about signs and symptoms of cancer, risk factors, and the value of early detection. Mobile screening vehicles, street plays, local radio campaigns, and testimonies by survivors can encourage participation and help in reducing stigma.
6. Public-Private Partnerships
Partnerships with private hospitals, pharma companies, and NGOs can attract much-needed resources and expertise. BOT or viability gap funding models can be tried for viable operations.
7. Research and Innovation
Last but not least, DCCCs can also be centers for local research—monitoring cancer patterns, piloting low-cost diagnostic equipment, and developing context-relevant treatment protocols. Facilitating locally relevant research can influence policy decisions in the future.
CONCLUSION
Opening up Daycare Cancer Centres in all district hospitals is a revolutionary measure towards the decentralization of cancer care in India. With bringing services within easier reach of the patient, the program vows to enhance accessibility, lower the cost burden, and facilitate early detection and treatment. For this policy to become successful, though, concerted action has to be taken to remove infrastructural lacunas, develop health care human resources, implement financial integration, and activate the communities.
With strategic planning, effective implementation, and continued political and financial support, DCCCs can be a cornerstone in India’s fight against cancer. The effort not only fortifies the public healthcare system but also reiterates the government’s resolve for universal health coverage and accessible healthcare to all.
References
- Ministry of Health and Family Welfare. (2024). Press release on Day Care Cancer Centres. https://www.mohfw.gov.in
- Indian Express. (2024). Cancer centre at district hospitals. https://indianexpress.com/article/health-wellness/cancer-centre-at-district-hospitals-trained-staff-chemotherapy-4-6-beds-9891522
- National Health Policy. (2017). Ministry of Health and Family Welfare. https://nhsrcindia.org
- National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke. https://nhm.gov.in
- India Today. (2025). Government reviewing district hospitals for cancer centres. https://www.indiatoday.in/india/story/government-reviewing-district-hospitals-for-setting-up-daycare-cancer-centres-2684342-2025-02-23
- Business Standard. (2025). Govt reviewing infra of hospitals. https://www.business-standard.com/india-news/govt-reviewing-infra-of-hospitals-for-setting-up-daycare-cancer-centres-125022300198_1.html
- Live Mint. (2025). Budget proposal for 200 cancer centres. https://www.livemint.com/science/budget-proposal-for-200-cancer-care-centres-not-enough-skilled-oncologists-nurses-and-equipment-needed-say-experts-11738562938247.html
- Health Economic Times. (2024). Cancer treatment under PMJAY. https://health.economictimes.indiatimes.com/news/policy/over-68-lakh-cancer-treatments-done-under-pmjay-majority-in-rural-areas-nadda/119185208
- Express Healthcare. (2024). India and access to cancer care. https://www.expresshealthcare.in/news/india-can-take-a-big-leap-in-cancer-care-with-improved-access-to-treatment-and-people-centered-approach-experts/447949
- PMC. (2021). Challenges in cancer care. https://pmc.ncbi.nlm.nih.gov/articles/PMC8325187
About the Contributor– Arjun Brij is a Policy Research Intern at the Impact and Policy Research Institute and holds a B.A. (Hons) in History from University of Delhi.
Acknowledgment: The author extends sincere gratitude to Dr. Arjun Kumar and Aasthaba Jadeja for their invaluable guidance and support.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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