The Centre is set to add over 4,500 cancer daycare beds in district hospitals over the next three years, bringing it closer to the bed availability in the private sector.Sector experts, however, caution that the manpower to manage these beds could be a challenge, and public-private partnership (PPP) and hub-and-spoke delivery model will be developed. Finance Minister Nirmala Sitharaman announced plans to establish daycare cancer centres in all district hospitals within three years, with 200 of them opening in 2025-26.

A senior government official said the plan is to have around six beds at every district hospital. As of June 2024, India has around 759 district hospitals, and this works out to be 4,554 beds in three years. In 2025-26 itself, around 1,200 daycare beds would be operational.
It can be impactful as experts feel that almost 70 per cent of cancer treatment can be delivered through the daycare mode. At the moment, the private sector has around 6,000 cancer beds, said BS Ajaikumar, executive chairman, HealthCare Global Enterprises (HCG). He clarified that several multi-special- ity hospitals do not have exclusively demarcated cancer beds and much of the treatment also happen in out-patient mode. Therefore, private sector capacity is actually fungible and can be up to 8,000 beds at the moment. HCG, the market leader, has around 2,000 beds.

India urgently needs cancer treatment infrastructure with a crude incidence rate of 100.4 cases per 100,000 people. Around one in nine in India is likely to face a cancer diagnosis during their lifetime. An estimated 12.8 per cent rise in cancer inci- dence by 2025 is expected as compared to 2020. According to the National Centre for Disease Informatics and Research (ICMR- NCDIR), the projected cancer burden in India is expected to rise from 26.7 million disability adjusted life years (adjusted mortality to incidence) in 2021 to 29.8 million in 2025. Among non-communicable diseases, cardiovascular disease contributes the most to the death rate (63.3 per cent), followed by cancer (18.1 per cent). Ajaikumar, an oncologist with over 50 years of experience, said these centres mode. Therefore, private sector capacity is would typically need to do chemotherapies, and biopsies apart from minor procedures like blood transfusion, among others.

"They have not mentioned anything around radiol- ogy treatment, and I don't expect these daycare centres to have radiology services as well. But, the daycare beds would also need highly trained manpower as cancer is not a one-size-fits-all disease. It is get- ting highly customised for each patient with genomic testing, so that the inci- dences of recurrence are less," he added. This is where the challenge also lies. Do we have enough trained oncolo- gists and medical professionals in India to man these over 4,500 beds in the public sector? Some recent reports suggest that several states are grappling with vacant medical seats. Odisha has more than 5,000 posts vacant for doctors in govern- ment hospitals as of December 2024. Against the sanctioned posts of 2,689 specialist doctors, 1,559 are lying vacant in Punjab, while the corresponding figure for MBBS doctors is 1,028 out of 2,293. In Tamil Nadu, more than 5,000 posts out of the sanctioned 18,000 were lying vacant as of October. As such, India has 1.38 million practitioners of modern med- icine registered as of July converting into one medical professional per 1,263 people. The latest Economic Survey claimed that India is on track to touch the World Health Organization standard norm of one doctor for every 1,000 people by 2030. The Centre plans to offer 75,000 medi- cal seats in the next 5 years. It roughly churns out 300 oncologists a year. 

The Survey also highlighted that the availability is skewed in favour of urban areas with urban to rural doctor density ratio being 3.8:1. It has been estimated that 75 per cent of dispensaries and 60 per cent hospitals are in urban areas, where 80 per cent of doctors serve. A former state government official said that in order to bridge this gap of manpo- wer, the government is likely to plan hub- and-spoke models for delivering these services. It will also look at PPP projects.

"A city medical college can serve as the hub which will have specialist doctors and a war room of sorts that will oversee the service delivery in spokes or district hospitals. Such models have been adopted in the area of dialysis. There are post graduate (PG) medical colleges where specialist doctors and students, who are pursuing a PhD in nephrology, often man these war rooms," said the official. He said PPPs will hold key to these projects as well. The patients can visit the city hospital for diagnosis and treatment plan, and the subsequent treatment can be delivered at the spokes. "At times, patients travel 100s of kms to get their chemotherapy done and the dropout rates are thus high. Having daycare beds would reduce this burden on patients," he said. The Centre is running daycare cancer centres under the National Programme for Prevention and Control of NCD (NP- NCD). Currently, there are 372 daycare cancer centres in India under the NPNCD.