Monday, November 23, 2009

Cancer & Public Sector Spending: 11th Plan

Cancer has become an important public health problem in India with an estimated 7 to 9 lakh cases
occurring every year. At any point of time, it is estimated that there are nearly 25 lakh cases in the country. The strategy under the National Cancer Control Programme (NCCP) was revised in 1984–85 and further in 2004 with stress on primary prevention and early detection of cancer cases. In India, tobacco related cancers account for about half the total cancers among men and 20% among women. About one million tobacco related deaths occur each year, making tobacco related health issues a major public health concern.


During the Tenth Five Year Plan, a taskforce comprising experts from across the country was
constituted. Based on recommendations from the national taskforce a comprehensive NCCP will be
implemented during the Plan. The main activities during the Plan will be:
• Establishing new Regional Cancer Centres
• Upgradation of the existing Regional Cancer Centres based on their performance and linkages with
other cancer organizations in the region.
• Creating skilled human resources for quality cancer care services
• Training health care providers for early detection of cancers at primary and secondary level
• Increasing accessibility and availability of cancer care services
• Providing behavioural change communication along with provision of cost effective screening
techniques and early detection services at the door step of community
• Propagating self-screening of common cancers (oral, breast)
• Upgrading Oncology Wings in government medical colleges
• Creating and upgrading Cancer detection and Surgical and Medical Treatment facilities in District Hospitals/Charitable/NGO/Private Hospitals
• Promoting research on effective strategies of prevention, community-based screening, early
diagnosis, environmental, and behavioural factors associated with cancers and development of cost
effective vaccines
• Creating Palliative Care and Rehabilitation Centres
• Monitoring, Evaluation, and Surveillance

As per NSSO 60th Round, during 2004, 24% of the episodes of ailments among the poor were
untreated in rural areas and 22% in urban areas. Lack of finances was cited as a reason by 28% of persons with untreated episodes in rural areas and 20% in urban areas. It is also notable that 12% cited lack of medical facility as the cause of not receiving treatment in rural areas.

Public spending on health in India is amongst the lowest in the world (about 1% of GDP), whereas
its proportion of private spending on health is one of the highest. Households in India spend about 5–6% of their consumption expenditure on health (NSSO). The cost of services in the private sector makes it unaffordable for the poor and the underprivileged.

The cost of health care in the private sector is much higher than the public sector. Many small
providers have poor knowledge base and tend to follow irrational, ineffective, and sometimes even harmful practices for treating minor ailments. Bulk of the qualified medical practitioners and nurses are subject to self-regulation by their respective State Medical Councils under central legislation. In practice, however, regulation of these professionals is weak and close
to non-existent.

We have a huge working population of about 400 million. Almost 93% of this work force is in the
unorganized sector. There are numerous occupational groups in economic activities, passed on from generation to generation, scattered all over the country with differing employer–employee relationship. Those in the organized sector of the economy, whether in the public or private sector, have access to some form of health service coverage. The unorganized sector workers have no access. The National Commission for Enterprises in the Unorganized Sector (NCEUS) has recommended a specific scheme for health in incidences of illness and hospitalization for workers
and their families.

The Eleventh Five Year Plan will introduce a new scheme based on cashless transaction with the
objective of improving access to health care and protecting the individual and her family from exorbitant out-of-pocket expenses. Under the scheme, coverage will be given to the beneficiary and her family of five members. Providers will be both public and private.

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