With over 1 million cases added annually, cancer poses a major and burgeoning public health challenge for India. The International Agency for Research on Cancer’s GLOBOCAN project estimates that India’s cancer burden will nearly double by 2035. Yet, affordability and the provision of adequate health personnel and infrastructure remain serious obstacles to ensuring proper care. Especially glaring is the absence of oncologists in all three branches of the discipline — medicine, surgery and radiation. India produces only 15 surgical oncologists each year; experts estimate that at least three times as many are needed. In the 11th Five Year Plan, the health ministry noted that the country needed to train 100 medical oncologists per year, up from 20-25. But the current doctor-patient ratio is about 1:2,000. Given the tightly controlled supply of specialty training for doctors, this is unlikely to improve in the short to medium term.
This scarcity, across the medical profession but all the more acute in cancer treatment, contributes to a situation where despite lower rates of incidence of the disease, India’s mortality burden is close to that of high-income countries. The absence of trained personnel leads to low rates of early-stage detection and poor treatment outcomes, particularly in rural areas. Here, the problem of detection is exacerbated by the near-total lack of access to specialist care. More than 90 per cent of patients from rural areas first present with cancer to practitioners who, for the most part, have no allopathic qualifications.
Given that cancer centres are concentrated in urban areas, delivering equitable and affordable cancer care is a great test — one that the government and the Medical Council of India are failing. The MCI in particular is responsible for creating a scarcity in the supply of health professionals by throttling medical education at all levels. Under the garb of ensuring quality training, the MCI has consistently resisted attempts to expand MBBS programmes, and has zealously protected its turf in the more profitable realm of postgraduate education.
Limited seats mean that doctors are forced to seek specialised training abroad, and they often choose not to return. If the government wishes to address the skews in cancer care, it must begin by addressing the severe shortage of training facilities.