Lok Sabha Question No. 1107 (UNSTARRED), answered on 2020-09-18
Subject: Expenditure on Cancer Treatment
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Dushyant Singh, Sangamlal Kadedin Gupta

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1107 TO BE ANSWERED ON 18 TH SEPTEMBER, 2020

## EXPENDITURE ON CANCE R TREATMENT

## 1107. SHRI DUSHYANT SINGH: SHRI SANGAM LAL GUPTA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  the  number  of  National  Cancer  Centres  operational across  the  country,  State/UT -wise including Uttar Pradesh;
- (b) the total number of patients affected with cancer alongwith the year wise data of the number of persons visiting government hospitals to avail treatment, year - wise;
- (c) the average distance that has to be travelled by cancer patients in order to avail treatment;
- (d) the requirement of radiotherapy machines per million population along with the number of radiotherapy machines available in the country;
- (e) the charges for cancer treatment in government hospitals vis - à- vis  its  private  counterparts along  with the  number  of  people  who  go  below  poverty  line because  o f  the  out  of  pocket expenditure on treatment of cancer;
- (f) whether there is difference between the salary given to doctors treating cancer patients in governmentcompared to the private hospitals, if so, the details thereof; and
- (g) whether the  government is planning to set up 'hub  and  spoke'  model  to  augment  cancer treatment infrastructure in the country, if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a) Public Health and Hospitals is a State subject. However, t o enhance the facilities for tertiary care  of  cancer,  the  Central  Government  is  implementing  Strengthening  of  Tertiary  Care Cancer Scheme, under which setting up of 19 State Cancer Institute s (SCIs) and 20 Tertiary Care Cancer Centres (TCCCs) have been approved. The list of such approved SCIs/TCCCs in the country including in the State of Uttar Pradesh, is at Annexure . In addition, following Cancer Centres under the Department of Atomic Energ y, Government of India are operational across the country :

## 1. Maharashtra

- (I) Tata Memorial Hospital (TMH), Parel, Mumbai
- (II) Advance centre for treatment and Research in Cancer (ACTREC), Kharghar, Navi Mumbai
2. Andhra Pradesh
- (I) Homi Bhabha Cancer Hospital & Resea rch Centre (HBCH&RC), Visakhapatnam
3. Uttar Pradesh
- (i) Homi Bhabha Cancer Hospital (HBCH) , Varanasi
- (ii) Mahamana Pandit Madan Mohan Malaviya  (MPMMCC), Varanasi
4. Punjab
- (i) Homi Bhabha Cancer Hospital (HBCH), Sangrur

## 5. Assam

(i) Dr. BhubaneswarBorooah Cancer Institute, Guwahati Further, Oncology is also one  of  the  focus  areas  in  case  of  new  AIIMS  and  many  upgraded  institutions  und Pradhan  Mantri  Swasthya  Suraksha  Yojana  (PMSSY).  Setting  up  of  National  Cancer Institute  at  Jhajjar  in  Haryana  and strengthening  of  Chittaranjan  National  Cancer Institute, Kolkata, are also steps in the same direction.

(b) and (c): The information regarding estimated incidence of cancer cases in the countr based on National Cancer Registry Programme (NCRP) of Indian Council of Medical Research. The latest report of NCRP is for the year 2020, which is based on data for the period 201 - 16, as compared to earlier report of 2016, which was based on data for the period 2012 - 14. Also the year 2020 report is based on an increased coverage in terms of more number of Population Based Cancer Registries (PBCRs) or expansion of some existing PBCRs. As a result of above chang the annual figures of estimated incidence of cancer in the country in the year 2020 rep undergone revision as compared to previous report of NCRP of 2016, and the revised year -wise figures are as under:

| Year                             | 2017         | 2018      | 2019      |
|----------------------------------|--------------|-----------|-----------|
| Estimated Incidence Cancer Cases | of 12,92,534 | 13,25,232 | 13,58,415 |

The cancer patients are diagnosed and treated by different specialties at various levels in the healthcare delivery system including medical colleges, district hospitals and other ter institutions of state and central government. T he information regarding the number of persons visiting governme nt hospitals to avail treatment and the average distance that has to be travelled by cancer patients in order to avail treatment is not maintained centrally.

(d): Department of Atomic Energy has informed that with an estimated requirement of 2 ext ra diotherapy machine per million population and 40% to 60 % of patients requiring radiothe there  is  shortfall  in  availability  of  machine  in  the  country.  Currently  there  are  a machines in the country.

(e): In Government hospitals, treatment is either free or highly subsidized. Treatment of cancers is  also  available  under  Ayushman  Bharat - Pradhan  Mantri  Jan  Arogya  Yojana  (PMJAY). Besides this, Affordable Medicines and Reliable Implants for Treatment (AMRIT) Deendaya outlets have been opened at 210 Institutions/Hospitals with an objective to make available dru and  implants  at  discounted  prices  to  the  patients.  Under  the  umbrella  scheme  of  Ras Arogya Nidhi, financial assistance is provided to families living below threshold poverty r their treatment, including treatment of cancer, in Government hospitals.

(f): Cancer is diagnosed and treated at various levels in the Government health care syst well as in the private hospitals. While doctors with D. M. (Medical Oncology), M.Ch (Sur Oncology)  and  M.D.  (Radiation  Oncology)  treat  Cancer  patients  in  higher level  tertiary  care hospitals, Cancer is also being treated in hospitals by other Doctors such as General S Gynecologists, ENT Surgeons etc., depending on the type and site of Cancer. In Government facilities, salary is on the basis of post held b y  the person  and  the  institution  they  work  for . Information regarding salary in private hospitals is not available.

(g): The Hub and Spoke model stands for a network of hospitals on two levels. SCI s/TCCC s are envisaged for cancer treatment as Hub and Spoke for providing cancer care, giving suppo district  hospitals  and  medical  colleges.  SCI s  serve as  the  nodal  Institution  to  mentor  other Government  Institutes.  Similarly  the  TCCC  mentor  cancer  related  a ctivities  including  at  the district level and below in their respective area s. SCI acts as hub and TCCCs as spokes, and facilities  being  created  under  NHM -District  NCD  clinics,  CHC  NCD  clinics,  Day  Care Centres -as sub - spokes.

## Statement r eferred to in reply to part (a) of the Lok Sabha Unstarred Question No. 1107 due for reply on 18.09.2020.

## State/UT- wise  list  of  approved State  Cancer  Institutes  (SCI)  and  Tertiary  Care  Cancer Centres (TCCCs).

|   S No | State            | Name of the Institute                                  | SCI/ TCCC    |
|--------|------------------|--------------------------------------------------------|--------------|
|      1 | Andhra Pradesh   | Kurnool Medical College, Kurnool                       | SCI          |
|      2 | Assam            | Gauhati Medical College & Hospital, Guwahati           | SCI          |
|      3 | Bihar            | Indira Gandhi Institute of Medical Sciences,           | Patna SCI    |
|      4 | Chhattisgarh     | Chhattisgarh Institute of Medical Sciences,            | BilaspurSCI  |
|      5 | Delhi            | Lok Nayak Hospital                                     | TCCC         |
|      6 | Gujarat          | Gujarat Cancer Research Institute, Ahmedabad           | SCI          |
|      7 | Goa              | Goa Medical College, Panaji                            | TCCC         |
|      8 | Haryana          | Civil Hospital, Ambala Cantt                           | TCCC         |
|      9 | Himachal Pradesh | Indira Gandhi Medical College, Shimla                  | TCCC         |
|     10 |                  | Shri Lal Bahadur Shastri Medical College, Mandi        | TCCC         |
|     11 | Jammu & Kashmir  | Sher - i - Kashmir Institute of Medical Sciences,      | Srinagar SCI |
|     12 |                  | Government Medical College, Jammu                      | SCI          |
|     13 | Jharkhand        | Rajendra Institute of Medical Sciences,                | Ranchi SCI   |
|     14 | Karnataka        | Kidwai Memorial Institute of Oncology (RCC), Bangaluru | SCI          |
|     15 |                  | Mandya Institute of Medical Sciences, Mandya           | TCCC         |
|     16 | Kerala           | Regional Cancer Centre, Thiruvananthapuram             | SCI          |
|     17 |                  | Government Medical College, Kozhikode                  | TCCC         |
|     18 | Madhya Pradesh   | G.R. Medical College, Gwalior                          | TCCC         |
|     19 |                  | Netaji Subhas Chandra Bose Medical College,            | JabalpurSCI  |

|   20 | Maharashtra   | Rashtrasant Tukdoji Regional Cancer Hospital & Centre, Nagpur   | Research TCCC   |
|------|---------------|-----------------------------------------------------------------|-----------------|
|   21 | Maharashtra   | Government Medical College, Aurangabad                          | SCI             |
|   22 | Maharashtra   | Vivekanand Foundation & Research Centre, Latur                  | TCCC            |
|   23 | Mizoram       | Mizoram State Cancer Institute, Aizawl                          | TCCC            |
|   24 | Nagaland      | District Hospital, Kohima                                       | TCCC            |
|   25 | Odisha        | Acharya Harihar Regional Cancer Centre, Cuttack                 | SCI             |
|   26 | Punjab        | Government Medical College, Amritsar                            | SCI             |
|   27 | Punjab        | Civil Hospital, Fazilka                                         | TCCC            |
|   28 | Rajasthan     | S P Medical College, Bikaner                                    | TCCC            |
|   29 | Rajasthan     | SMS Medical College, Jaipur                                     | SCI             |
|   30 | Rajasthan     | Jhalawar Medical College & Hospital, Jhalawar                   | TCCC            |
|   31 | Sikkim        | Multispecialty Hospital at Sochygang (Sichey), near Sikkim      | Gangtok, TCCC   |
|   32 | Tamil Nadu    | Cancer Institute (RCC), Adyar, Chennai                          | SCI             |
|   33 | Telangana     | MNJ Institute of Oncology & RCC, Hyderabad                      | SCI             |
|   34 | Tripura       | Cancer Hospital (RCC), Agartala                                 | SCI             |
|   35 | Uttar Pradesh | Sanjay Gandhi Postgraduate Institute of Medical Lucknow         | Sciences, TCCC  |
|   36 | Uttarakhand   | Government Medical College, Haldwani                            | SCI             |
|   37 | West Bengal   | Government Medical College, Burdwan                             | TCCC            |
|   38 | West Bengal   | Murshidabad Medical College & Hospital, Berhampore, Murshidabad | TCCC            |
|   39 | West Bengal   | Sagore Dutta Memorial Medical College and Hospital, Kolkata     | TCCC            |