Lok Sabha Question No. 2186 (UNSTARRED), answered on 2016-07-29
Subject: Cancer Centres with Private Sector Participation
Ministry: HEALTH AND FAMILY WELFARE
Asked by: BHARAT SINGH, R.P. MARUTHARAJAA, VIJAY KUMAR HANSDAK, RAMESH POKHRIYAL NISHANK

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

## LOK SABHA UNSTARRED QUESTION NO. 2186 TO BE ANSWERED ON 29 TH JULY, 2016

## CANCER CENTRES WITH PRIVATE SECTOR PARTICIPATION

2186. SHRI BHARAT SINGH: SHRI R.P.MARUTHARAJAA: SHRI VIJAY KUMAR HANSDAK: DR. RAMESH POKHRIYAL "NISHANK":

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

- (a)  whether  any  special  scheme  has  been prepared  for  cancer  screening  in  far -flungrural unaccessible hilly  areas  of  the  country especially  in  Uttar  Pradesh,  Bihar, Jharkhand  and Uttarakhand, if so, the details thereof;
- (b)  whether  any  regional  cancer  centres have  been  opened  in  the  country  including Uttar Pradesh, Bihar, Jharkhand, Uttarakhand and all H imalayan States, if so, the details thereof;
- (c)  whether  the  Government  proposes to  open  regional  cancer  centres  in collaboration  with private sector hospitals, if so, the details thereof and the steps taken by the Government to ensure availability ofcancer drugs in remote, rural and unaccessible and backward areas;

(d) whether Government proposes to provide free treatment to Below Poverty Line (BPL) people suffering from cancer at Government hospitals/super speciality hospitals, if so, the details th ereof and the funds allocated/utilised, State/UT - wise; and

- (e) the monitoring mechanism put in place by the Government to ensure proper utilisation of the allocated fund for the intended purpose?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SMT. ANUPRIYA PATEL )

(a) to (e): The Government of India is implementing a National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) under Nation Health  Mission  (NHM)  in  all  the  States/UTs  including Uttar  Pradesh,  Bihar,  Jharkhand, Uttarakhand & Hilly States for intervention upto district level. The objectives include a generation  for  prevention,  screening,  early  detection  and  referral  to  an  appropria institution for treatment.  For Cancer, the focus of the programme is on Breast, Cervical and Oral Cancer. Operational  guidelines  have  been recentlyreleased  for  prevention,  control  and population level screening of Diabetes, Hypertension and common Cancer (Cervix, Breast Oral) to all the States for implementation inclu dingUttar Pradesh, Bihar, Jharkhand, Uttarakhand and all Himalayan States .

Regional  Cancer  Centres  (RCCs)  were  recognized  and  supported  under  the  erstwhil National Cancer Control Programme (NCCP) for treatment of cancer patients. The scheme is longe r  being  implemented  and  there  is  no  proposal  to  open  regional  cancer  centres collaboration with any private sector hospitals. The list of RCCs in the country incl Uttar  Pradesh,  Bihar,  Jharkhand,  Uttarakhand  and  all  Himalayan  States,  recognized under erstwhile NCCP is at Annexure - I.

Under current Five Year Plan, a Tertiary Care for Cancer scheme is being implement under which support is being provided to set up/establish State Cancer Institutes and Care Cancer Centres in different par ts of the country.  These institutions will mentor all Canc related  activities  including  prevention,  awareness  generation,  research  and  treatment respective jurisdiction.

Provisioning  of  drugs  is  supported  under  NHM  and  NPCDCS.  The  list  of  medi cines specified in the National List of Essential Medicines (NLEM) which are included in the Schedule of Drug Pricing Control Order (DPCO), 2013 also contain drugs used for the treat of Cancer for which ceiling prices have been fixed. Most of the sta es are providing essential drugs, including certain cancer drugs free of cost to patients who come to public health f

Affordable  Medicines  and  Reliable  Implants  for  Treatment  (AMRIT)  outlet  has  been opened at All India Institute of Medical Sciences, New Delhi and 6 other Institutions objective to make available Cancer and Cardiovascular drugs and implants at reaso nable prices to the patients. M/s HLL Lifecare Ltd, which is a 100% Government of India owned PSU und this Ministry, has been directed to contact all States which may like to open AMRIT out major  State  Government  hospitals/institutions.  As  per  the approval  accorded  for  setting  up AMRIT, the prices of the products are to be reasonable and significantly lower than the price.

The treatment for cancer in Government Hospitals is either free or subsidized. In a to  Cancer  diagnosis  and  tre atment  by  the  State  Governments  Health  Institutes,  the  Central Government Institutions such as All India Institute of Medical   Sciences, Safdurjung Ho Dr  Ram  Manohar  Lohia  Hospital,  PGIMER  Chandigarh,  JIPMER  Puducherry,  Chittaranjan National Cancer Institute, Kolkata, etc. provide facilities for diagnosis and treatment of C

The Government is providing financial assistance to patients living below poverty li life threatening diseases under the schemes Rashtriya Arogya Nidhi (RAN), Health Minister's Cancer  Patient  Fund  (HMCPF),  State  Illness  Assistance  Fund  (SIAF)  and  Health  Minister's Discretionary Grant (HMDG). The details are given as under:

- I. Rashtriya Arogya Nidhi has been set up to provide financial  assistance  to  patie nts,  living  below  poverty  line  who  are  suffering  from major life threatening diseases, to receive medical treatment at any of the super specialty Government hospital/ institute. Revolving Funds have been set up in 13 Central Government Hospitals/Institu tes and funds upto Rs. 50 lakhs are placed at their disposal for providi treatment upto Rs. 2 lakh in each case. Cases involving treatment  beyond  2  lakh  are  referred  to  Ministry  of  Health  &  Family  Welfar Government of India for providing funds. The details of funds utilized during 2015 - 16 under the scheme is at Annexure - II .
- II. All  State  Governments/UT  Administrations  have  been  advised  to  set  up  an  Illne Assistance Fund in respective States/UTs. It has been decided that grant - in - aid from Central Gove rnment would be released to each of these States/UTs (with Legislatur where such Funds are set up. The Grant - in - aid to States/UTs would be to the extent of 50%  of  the  contributions  made  by  the  State  Governments/UTs  to  the  State Fund/Society subject to a maximum of Rs. 5 crore to States with higher percentage of population  below  poverty  line  and  Rs.  2  crore  for  smaller  States.  The  Ill Assistance  Fund  at  the  State/UT  level  can  release  financial  assistance  to  pa living  in  their  respective  States/UT up  to  Rs.  1.50  lakh  in  an  individual  case  and forward all such cases to Rashtriya Arogya Nidhi Headquarters, where the quantum financial  assistance  is  likely  to  exceed  Rs.  1.50  lakh. The  details  of  funds  utilized under the scheme is at Annexure - III .
- III. H ealth Minister's Cancer Patient Fund (HMCPF) has been set up to provide financial assistance to the poor patients suffering from cancer. A Corpus Fund of Rs. 100 has been set up, which has been placed in fixed deposit. Interest accrued ther uti lized to provide the financial assistance.
- IV. Financial assistance towards treatment for cancer is provided to the patients treatment in 27 Regional Cancer Centres (RCC), as per guidelines. Revolving Fun have been set up in 27 RCCs and funds upto 50 lakhs are placed at their disposal for providing treatment upto Rs. 2 lakh in each case. Cases involving treatment beyo lakh are referred to Ministry of Health & Family Welfare, Government of India. details of funds utilized under the scheme by th e RCCs is at Annexure - IV . Release of assistance directly to hospitals for treatment of cancer patients is at Annexure - V .
- V. Under  the  scheme  Health  Minister's  Discretionary  Grant  (HMDG),  patients  having annual  family  income  of  less  than  Rs.  1,25,000/ - are  pr ovided  financial  assistance upto Rs. 1,25,000/ -as per guidelines of the scheme to defray a part of expenditure hospitalization/treatment. The details of funds utilized under above schemes Sta wise is at Annexure - VI .

The accounts of Rashtriya Arog ya Nidhi are audited by Chartered Accountants as well as by the CAG. The utilization certificates in the form of GFR 19 - A are received from the hospitals are scrutinised before release of further funds from the RAN/HMCPF/SIAF schemes.

There  are  multiple  m onitoring  mechanisms  including  performance  audit  by  CAG  and statutory audit through which the programmes under NHM including NPCDCS are monitored. In addition, regional review meetings are also held under NPCDCS. Regular coordination the States/UTs i s maintained for effective implementation of scheme and programme.

## List of Regional Cancer Centres recognized under National Cancer Control Programme

|   S No. | Name of State / Union Territory   | Name of the Institution                                                         |
|---------|-----------------------------------|---------------------------------------------------------------------------------|
|       1 | Andhra Pradesh                    | M.N.J. Institute of Oncology& Regional Cancer Centre, Hyderabad.                |
|       2 | Assam                             | Dr. B. Borooah Cancer Institute, Guwahati.                                      |
|       3 | Bihar                             | Indira Gandhi Institute of Medical Sciences, Patna.                             |
|       4 | Chandigarh                        | Post Graduate Institute Medical Education &Research, Chandigarh                 |
|       5 | Chhattisgarh                      | Pt. J.L.N Medical College &Dr. B. R. Ambedkar Memorial Hospital, Raipur         |
|       6 | Delhi                             | Dr.B.R.Ambedkar. Institute - Rotary Cancer Hospital, AIIMS,New Delhi            |
|       7 | Gujarat                           | The Gujarat Cancer &Research Institute, Ahmedabad.                              |
|       8 | Haryana                           | Post Graduate Institute of Medical Sciences, Rohtak.                            |
|       9 | Himachal Pradesh                  | Indira Gandhi Medical College, Shimla.                                          |
|      10 | Jammu &Kashmir                    | Sher-I-Kashmir Institute of Medical Sciences, Srinagar.                         |
|      11 | Jammu &Kashmir                    | Government Medical College, Jammu.                                              |
|      12 | Karnataka                         | Kidwai Memorial Institute of Oncology, Bangalore.                               |
|      13 | Kerala                            | Regional Cancer Centre, Thiruvananthapuram.                                     |
|      14 | Madhya Pradesh                    | Cancer Hospital& Research Institute, Gwalior.                                   |
|      15 | Maharashtra                       | Rashtrasant Tukdoji Regional Cancer Hospital& Research Centre, Nagpur.          |
|      16 | Maharashtra                       | Tata Memorial Hospital, Mumbai.                                                 |
|      17 | Manipur                           | Regional Institute of Medical Sciences, Imphal.                                 |
|      18 | Mizoram                           | Civil Hospital, Aizawl.                                                         |
|      19 | Orissa                            | Acharya Harihar Regional Cancer Centre, Cuttack.                                |
|      20 | Puducherry                        | Jawaharlal Institute of Postgraduate medical Education & Research               |
|      21 | Rajasthan                         | Acharya Tulsi Regional Cancer Treatment &Research Institute, Bikaner.           |
|      22 | Tamil Nadu                        | Govt. Arignar Anna Memorial Cancer Research Institute & Hospital, Kancheepuram. |
|      23 | Tamil Nadu                        | Cancer Institute (WIA), Adyar, Chennai.                                         |
|      24 | Tripura                           | Civil Hospital, Agratala.                                                       |
|      25 | Uttar Pradesh                     | Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.             |
|      26 | Uttar Pradesh                     | Kamla Nehru Memorial Hospital, Allahabad.                                       |
|      27 | West Bengal                       | Chittaranjan National Cancer Institute, Calcutta.                               |

State wise break up of financial assistance provided under Rashtriya Arogya Nidhi (RAN) (Rs. in Lakhs)

| S     |                   | 2015-16        | 2015-16   |
|-------|-------------------|----------------|-----------|
| No.   | Name of State/UT  | No. of Patient | Amount    |
| 1     | Andhra Pradesh    | --             | --        |
| 2     | Arunachal Pradesh | --             | --        |
| 3     | Assam             | 4              | 14.6      |
| 4     | Bihar             | 85             | 380.37    |
| 5     | Chandigarh        | --             | --        |
| 6     | Chhattisgarh      | 3              | 8.48      |
| 7     | Delhi             | 10             | 48.94     |
| 8     | Gujarat           |                | --        |
| 9     | Haryana           | 23             | 118.7     |
| 10    | Himachal Pradesh  | 5              | 11.47     |
| 11    | J.& K.            | 35             | 77.05     |
| 12    | Jharkhand         | 5              | 24.55     |
| 13    | Karnataka         | --             | --        |
| 14    | Kerala            | 5              | 27.75     |
| 15    | Madhya Pradesh    | 13             | 56.64     |
| 16    | Maharashtra       | 2              | 9.25      |
| 17    | Manipur           | 5              | 27.9      |
| 18    | Mizoram           | 1              | 2         |
| 19    | Meghalaya         | 1              | 8.46      |
| 20    | Nagaland          | 1              | 5.5       |
| 21    | Odisha            | 3              | 9.46      |
| 22    | Punjab            | 2              | 4.66      |
| 23    | Rajasthan         | 7              | 28.25     |
| 24    | Sikkim            | --             | --        |
| 25    | Tamil Nadu        | --             | --        |
| 26    | Tripura           | --             | --        |
| 27    | Uttar Pradesh     | 143            | 524.24    |
| 28    | Uttarakhand       | 6              | 24.59     |
| 29    | West Bengal       | 17             | 63.34     |
| Total | Total             | 376            | 1476.2    |

## Details of funds allocated/released under State Illness Assistance Fund

(Rs. in Lakh)

| S.No       | Name of State     | 2015-16    |
|------------|-------------------|------------|
| 1          | Andhra Pradesh    | -          |
| 2          | Assam             | 250        |
| 3          | Arunachal Pradesh | -          |
| 4          | Bihar             | -          |
| 5          | Chhattisgarh      | -          |
| 6          | Goa               | -          |
| 7          | Gujarat           | -          |
| 8          | Himachal Pradesh  | -          |
| 9          | Haryana           | -          |
| 10         | J&K               | -          |
| 11         | Jharkhand         | -          |
| 12         | Karnataka         | -          |
| 13         | Kerala            | -          |
| 14         | Madhya Pradesh    | -          |
| 15         | Maharashtra       | -          |
| 16         | Manipur           | -          |
| 17         | Mizoram           | -          |
| 18         | NCT of Delhi      | -          |
| 19         | Odisha            | 500        |
| 20         | Puducherry        | 75         |
| 21         | Punjab            | -          |
| 22         | Rajasthan         | -          |
| 23         | Sikkim            | -          |
| 24         | Tamil nadu        | -          |
| 25         | Tripura           | -          |
| 26         | Uttar Pradesh     | -          |
| 27         | Uttarakhand       | -          |
| 28         | West Bengal       | 350        |
| 29         | Nagaland          | -          |
| 30         | Meghalaya         | -          |
| Total 1175 | Total 1175        | Total 1175 |

## Details  of  funds released  to  Regional  Cancer  Centre's  from  Health  Minister's  Cancer  Patient  Fund under RAN

(Rs. in Lakhs)

| S. No.   | Name of Centres (27 RCCs)                                                          | Amount (2015-16)   |
|----------|------------------------------------------------------------------------------------|--------------------|
| 1        | Acharya Harihar Regional Cancer Centre, Cuttack                                    | -                  |
| 2        | Acharya Tulsi Regional Cancer Trust &Research Institute Bikaner, Rajasthan         | -                  |
| 3        | Cancer Hos.Tripura, Agartala                                                       | -                  |
| 4        | Cancer Hospital& Research centre, Gwalior, Madhya Pradesh.                         | 375                |
| 5        | Chittaranjan National Cancer Institute, Kolkata,                                   | 20                 |
| 6        | Civl Hospital, Aizawl, Mizoram                                                     | -                  |
| 7        | Dr.B.B.Cancer Institute, Guwahati, Assam.                                          | 30                 |
| 8        | Govt. Arignar Anna Memorial Cancer Hospital, Kancheepuram, Tamil Nadu              | -                  |
| 9        | Govt. Medical College &Associate Hospital, Bakshi Nagar, Jammu.                    | -                  |
| 10       | Gujarat Cancer Researach Institute, Ahmedabad, Gujarat                             | -                  |
| 11       | Indian Rotary Cancer Institute , (AIIMS), New Delhi.                               | -                  |
| 12       | Indira Gandhi Institute of Medical Sciences, Patna, Bihar                          | -                  |
| 13       | Kamala Nehru Memo. Hospital, Allahabad, Uttar Pradesh.                             | 160                |
| 14       | Kidwai Memorial Institute of Oncology, Bangalore, Karnataka                        | 40                 |
| 15       | MNJ Institute of Oncology, Hyderabad, Andhra Pradesh.                              | -                  |
| 16       | Post Graduate Institute of Medical Education &Research, Chandigarh                 | 40                 |
| 17       | Pt. B.D.Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana.       | 10                 |
| 18       | Pt.J N MMedical College, Raipur, Chhattisgarh                                      | 20                 |
| 19       | Puducherry Regional Cancer Society, JIPMER, Puducherry                             | 10                 |
| 20       | Regional Cancer Centre, Thiruvananthapuram Kerala                                  | 20                 |
| 21       | Regional Cancer Control Society, Shimla, Himachal Pradesh                          | 25                 |
| 22       | Regional Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu                        | 179                |
| 23       | Regional Institute of Medical Sciences, Manipur, Imphal.                           | -                  |
| 24       | RST Hospital &Research Centre, Nagpur, Maharashtra.                                | -                  |
| 25       | Sanjay Gandhi Post Graduate Institute of Medical Sciences., Lucknow, Uttar Pradesh | -                  |
| 26       | Sher-I Kashmir Institute of Medical Sciences, Soura, Srinagar.                     | 30                 |
| 27       | Tata Memorial Hospital Mumbai, Maharashtra                                         | 20                 |
| Total    | Total                                                                              | 979                |

State  wise  break  up  of  financial  assistance provided  under  Health  Minister's  Cancer  Patient  Fund (HMCPF)

(Rs in Lakh)

| S No.   | Name of State/UT   | 2015-16        | 2015-16   |
|---------|--------------------|----------------|-----------|
| S No.   | Name of State/UT   | No. of Patient | Amount    |
| 1       | Andhra Pradesh     | 12             | 72.45     |
| 2       | Arunachal Pradesh  | --             | --        |
| 3       | Assam              | --             | --        |
| 4       | Bihar              | 60             | 306.28    |
| 5       | Chandigarh         | --             | --        |
| 6       | Chhattisgarh       | 2              | 21        |
| 7       | Delhi              | 4              | 33        |
| 8       | Gujarat            | --             | --        |
| 9       | Haryana            | 13             | 70.55     |
| 10      | Himachal Pradesh   | 5              | 45        |
| 11      | J.& K.             | 28             | 109.52    |
| 12      | Jharkhand          | 2              | 12.5      |
| 13      | Karnataka          | 1              | 5         |
| 14      | Kerala             | 1              | 6.3       |
| 15      | Madhya Pradesh     | 10             | 56.5      |
| 16      | Maharashtra        | 2              | 22        |
| 17      | Manipur            | --             | --        |
| 18      | Mizoram            | --             | --        |
| 19      | Meghalaya          | --             | --        |
| 20      | Odisha             | 1              | 5         |
| 21      | Punjab             | 1              | 5         |
| 22      | Rajasthan          | 2              | 10        |
| 23      | Sikkim             | --             | --        |
| 24      | Tamil Nadu         | 12             | 53.44     |
| 25      | Tripura            | --             | --        |
| 26      | Uttar Pradesh      | 74             | 424.4     |
| 27      | Uttarakhand        | 6              | 33.42     |
| 28      | West Bengal        | 24             | 93.4      |
| Total   | Total              | 260            | 1384.76   |

## Details of funds released under Health Minister's Discretionary Grant (HMDG)

(Rs. in Lakh)

| S No.   | Name of State/UT   | 2015-16        | 2015-16   |
|---------|--------------------|----------------|-----------|
| S No.   | Name of State/UT   | No. of Patient | Amount    |
| 1       | Andhra Pradesh     | --             | --        |
| 2       | Assam              | 1              | 0.5       |
| 3       | Bihar              | 111            | 84.96     |
| 4       | Chhattisgarh       | --             | --        |
| 5       | Delhi              | 28             | 21.45     |
| 6       | Haryana            | 5              | 4.25      |
| 7       | Himachal Pradesh   | 2              | 1.5       |
| 8       | J. & K.            | 16             | 12.75     |
| 9       | Jharkhand          | 3              | 2.5       |
| 10      | Karnataka          | --             | --        |
| 11      | Kerala             | 2              | 1.75      |
| 12      | Madhya Pradesh     | 10             | 7         |
| 13      | Maharashtra        | --             | --        |
| 14      | Manipur            | --             | --        |
| 15      | Meghalaya          | 5              | 4.25      |
| 16      | Odisha             | 2              | 1         |
| 17      | Punjab             | 2              | 1.75      |
| 18      | Rajasthan          | --             | --        |
| 19      | Tamil Nadu         | --             | --        |
| 20      | Uttar Pradesh      | 62             | 47.07     |
| 21      | Uttarakhand        | 1              | 1         |
| 22      | West Bengal        | 35             | 27.9      |
| Total   | Total              | 285            | 219.63    |