Expanding access to care through sustainable replicable model of care delivery.

Abstract

e13862 Background: Access to equitable care remains a major challenge. In most countries, access to specialized care is limited because of socioeconomic, geographical, and human resource constraints.To meet the challenge, multiple models are being tested worldwide: Buttaro, Australian, Canada, Montana, and District Cancer Care Model (Pendharkar model). The district model has evolved over more than ten years and has proven its sustainability, replicability, acceptability, and scalability. We offer a review of the 10 years of progress. Methods: In 2014, a cancer model was designed based on WHO framework of strengthening the health system. District hospitals in India are the peripheral pillars of the state-owned health system, where comprehensive care is feasible. Multiple regulations have been introduced to create district cancer units, empowering the delivery of cancer care from diagnosis to end-of-life. One physician was trained over a short period and offered a 24x7 hub and spoke mentorship in one state. In follow-up, other states of India independently reviewed the program and extended. Results: After launch in February 2014, over the last ten years, the program has been extended to eight states, nearly 200 districts, covering an area of 1200 million square kilometers and a population of 400 million. Five more states are committed to initiating the district cancer care model in 2025. More than 290 physicians and 550 nurses have been trained . The program offers consultation and chemotherapy services ,including free drugs,to more than 300,000 patients.The same units were trained to provide palliative care. The funding for the program is generated internally by the state and is available sustainably. The chemotherapy list has evolved annually and has gradually increased from 20 to 150 in a few states. It includes a complete basket of WHO essential oncology drug list. Conclusions: To date, this district cancer model based on the creation of an alternate oncology workforce using existing physical and human resources appears to be the most sustainable replicable model. Government-owned health systems, especially in LMIC, could be the single most important point of empowerment. Primary physicians can effectively offer patient-centric, consistent, and comprehensive services. Building and maintaining a decentralized and sustainable cancer care program is feasible. The district cancer care model can assist in improving access to care and resolving disparities. Data from the Rajasthan state district cancer care programme. Year Outpatient Visits Patient Number New In Patient Visits IV Chemo Oral Chemo Palliative Care 2018-19 48153 8069 20648 13070 2796 7709 2019-20 23113 3873 9911 6274 1342 3700 2020-21 37458 4781 16187 11751 2602 6040 2021-22 29937 4339 15883 11879 2681 5815 2022-23 33335 4887 16934 12316 3167 6204 2023-24(upto Oct. 23) 24144 2806 11756 10162 2381 4369 Total 196140 28755 91319 65452 14969 29468