No matter the time of day, the visitors in queue at Mumbai’s Tata Memorial Hospital (TMH) always have a discomfiting poise. Most have travelled long distances; but the group seems curated by one illness, cancer. An illness that can be manageable, like a chronic disease, but often isn’t.
In 2012, the leadership at TMH, the largest cancer centre in the country, took a decisive step to address parts of the colossal task at hand. Having brought existing centres in Guwahati, Chandigarh and Visakhapatnam into its fold that year, it set about framing common standards, setting up an IT platform, and sharing best practices—the entire structure for a functional network.
Then, in a benevolent gesture, they decided to open this up to scores of regional cancer centres across India. Thus, the National Cancer Grid (NCG) was born. An unprecedented initiative to tame a disease that the World Health Organisation (WHO) estimates will affect one in three household in India by next year. The numbers look ominous—1.73 million new cases by 2020, with only 12.3% of patients receiving early treatment.
Already under Ayushman Bharat—the government’s universal healthcare insurance scheme which covers 40% of the population—30% of reimbursements are for cancer treatment. Is that money optimally spent? It’s certainly worth examining since there are rumours the scheme may be expanded to cover more people.
Seven years on, the NCG sees 700,000 new cancer patients pass through its network of 177 centres each year. Some of the world’s leading cancer centres are even helping the NCG build out its capabilities since it’s also serving 40-plus countries in one way or another. These include the National Cancer Institute and American Society for Clinical Oncology in the US, King’s College London, and Cancer Research UK.
Fast emerging as a global health centre, could NCG also impact the sprawling, yet largely unregulated, private healthcare providers in India which serve the remaining 60% of cancer patients? CS Pramesh thinks it could. A director at TMH, Pramesh, a practising thoracic surgeon and the lead architect of NCG, talks about this democratic, ground-up machinery that has caught the world’s attention.
The Ken: Why have a cancer grid?
The single most important mandate of NCG is to have uniform standards of care. Look at the patients that come here or at any top centre; only a small percent comes from the state where the centre is. At TMH, only 15% of our patients come from Mumbai; 25% from other parts of Maharashtra. We geotagged 75,000 patients (map below). A large percentage comes from pockets like North, East, or North-East; not so much from the West or the South.
Overall, the biggest challenge for patients is to stay here with their family. Think of the cost of staying in Mumbai, the loss of income for the family… So our main aim was to provide the same level of care close to their homes.