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The Post-Budget Webinar held on March 5, 2025, focused on “Investing in People,” with a significant emphasis on enhancing India’s healthcare and medical education sectors.
Key highlights of Budget –
Expansion of Medical Education: Increase in Medical Seats: The government has approved the addition of 10,000 new medical seats for the current year, with a target of expanding the total by 75,000 over the next five years.
Establishment of Medical Colleges: Plans are underway to set up new medical colleges, including 10 new ESIC medical colleges, aiming to enhance healthcare infrastructure and education.
Healthcare Initiatives: Telemedicine and Digital Health: The expansion of telemedicine facilities across all Primary Health Centres and the development of digital healthcare infrastructure are prioritized to ensure quality healthcare reaches all citizens.
Daycare Cancer Centers: Initiatives to establish daycare cancer centers are being implemented to provide accessible and efficient cancer care.
Customs Duty Exemptions on Life-Saving Drugs – To improve access to essential medications, the
government has exempted 36 life-saving drugs, including those used for cancer and rare diseases, from basic customs duty. Additionally, six other essential medicines will now attract a reduced concessional duty of 5%.
Healthcare Coverage for Gig Workers: Recognizing the growing gig economy, the government will extend healthcare coverage under the PM Jan Arogya Yojana (PM-JAY) to gig workers. This move is expected to benefit nearly 1 crore gig workers, ensuring they have access to affordable healthcare services.
Promotion of Medical Tourism – ‘Heal in India’ Initiative: In a bid to boost medical tourism, the ‘Heal in India’ initiative has been introduced. The government aims to promote medical tourism in collaboration with the private sector, simplify visa norms for international patients, and establish India as a global healthcare hub.
Production-Linked Incentive (PLI) Scheme for Pharmaceuticals: The budget allocates ₹2,445 crore for the PLI scheme aimed at boosting the pharmaceutical industry. This initiative seeks to encourage domestic manufacturing and reduce dependency on imports for critical drugs and medical devices.
Infrastructure Requirements for Daycare Cancer Centers
Dr. Anurag Srivastava, former Head of the Department of Surgical Disciplines at AIIMS, New Delhi, highlighted the infrastructure and equipment needed for daycare cancer centers. The proposed centers would provide chemotherapy, radiotherapy (where feasible), palliative and supportive care, public education, and screening.
Chemotherapy Administration:
- Spacious treatment areas with a comfortable seating arrangement.
- Private consultation rooms to maintain patient confidentiality.
- Relaxing waiting areas to reassure patients.
- A large daycare room with 10–20 patient trolleys equipped with reclining heads, drip stands, and patient comfort mechanisms.
- Nurses and doctors’ workstations.
- Drug and intravenous fluid storage.
- Controlled drug locker for morphine and fentanyl.
- Handwashing sinks and toilets for staff and patients.
Radiation Therapy Facilities
- Linear accelerator and brachytherapy machine.
- An operation theater for brachytherapy.
- A radiation planning room.
- Dedicated rooms for radiation oncologists and physicists.
Medical Equipment Needs:
- One radiotherapy machines
- Imaging facilities such as CT scanner, ultrasound scanner, digital mammography, and MRI scanner.
- Laboratory equipment for blood cell counting, biochemistry tests, and histology preparation.
- HPV testing equipment for cervical cancer screening.
- ECG and echocardiogram machines to monitor chemotherapy-induced cardiotoxicity.
- Laminar airflow chambers for sterile drug preparation.
- Pulse oximeters, multi-channel monitors, BP monitors, body weight scales, and height measurement tools.
Patient Support and Follow-up Care:
- Clinical examination rooms for post-treatment follow-up.
- Facilities for yoga, pranayama, and meditation.
- Dietitian, clinical psychologist, and genetic counseling rooms.
- Patient support care spaces for NGOs like the Indian Cancer Society.
- IT and medical records room.
Supply Chain Management for Cancer Treatment
Dr. Prashant emphasized the need for a robust strategy to manage medicine supply efficiently. The classification of drugs was outlined as follows:
1. Drugs for Conventional Chemotherapy: Essential drugs for common cancers like breast, head and neck, cervix, lung, and sarcomas.
2. Supportive Treatment Drugs: Medication to manage chemotherapy side effects such as nausea, vomiting, and hypersensitivity reactions.
3. Complication Management: Antibiotics (cephalosporins, carbapenems, vancomycin), IV fluids, and emergency observation facilities.
4. Emergency Drugs: Hydrocortisone, antihistamines, and adrenaline for hypersensitivity reactions.
A real-time drug inventory tracking system should be implemented in district hospitals to ensure consistent supply, avoiding situations where a patient arrives for the next chemotherapy cycle but the required drug is unavailable.
Training and Standard Treatment Protocols
Dr. Hans Setty from the Homi Bhabha Cancer Hospital, Visakhapatnam, discussed the importance of standardized treatment protocols. He highlighted initiatives under the National Cancer Grid (NCG), which collaborates with the Andhra Pradesh government to train district hospital physicians, surgeons, and pediatricians.
Key Training Components:
- Adoption of NCG and ICMR treatment guidelines.
- First chemotherapy cycle to be administered at a comprehensive cancer center.
- Virtual tumor boards for patient evaluation before transitioning to district hospitals for further chemotherapy.
- Weekly virtual tumor board meetings for case discussions.
- Expansion of palliative chemotherapy in district centers to reduce the burden on apex cancer hospitals.
Role of Patient Counseling and Support Services
Ms. Jyotsna Govil, Chairperson of the Indian Cancer Society, emphasized the crucial role of patient counseling in improving treatment adherence and well-being.
Sahyog initiative
- One-on-one counseling for patients and caregivers.
- Guidance on financial constraints, legal matters, diet, and caregiving.
- Awareness programs through radio broadcasts in multiple languages.
- Community-driven support groups for cancer patients to share experiences.
- Free prosthetics, bras for mastectomy patients, and meals for patients undergoing treatment.
The organization also collaborates with the Ministry of HRD’s Swayam platform to provide free cancer awareness courses in English, Hindi, and Punjabi.
Staffing and Retention in Rural and Underserved Areas
Dr. Susanta Svend from Odisha discussed strategies to retain trained medical professionals in district hospitals. While financial incentives like ₹7,000 for medical officers and ₹3,000 for nurses exist under the Odisha Comprehensive Cancer Care Plan, they alone are not sufficient to retain staff.
Motivational Strategies:
- Recognizing district oncologists as key specialists, giving them respect and responsibility.
- Establishing professional connections with tertiary cancer centers.
- Career progression opportunities and ensuring that trained personnel are not frequently transferred.
- Training local physicians to develop confidence in chemotherapy administration.
Linkages Between District Daycare and Tertiary Cancer Centers
Dr. Kalpana from Adyar Cancer Institute stressed the importance of active coordination between district daycare centers and tertiary cancer hospitals.
Hub-and-Spoke model
- Expert guidance from oncologists at major cancer hospitals.
- Smooth referral pathways for complex cases.
- Integrated chemotherapy and palliative care across multiple centers.
- Regular monitoring of treatment efficacy and safety.
Swayam platform of the Ministry of HRD
- it is free of cost
- It is in English, in Hindi and Punjabi
- For communication between patients
- Every patient thinks that he or she is unique, pai is unique, side effect is unique but when he will talk to others within the same group of people suffering from that disease he will realize that he is not the only one.
Provision of Practical Aid
A notable initiative discussed was the provision of prosthesis and bras for children with retinoblastoma. This initiative reflects the deep concern and commitment to improving the quality of life for affected children. Additionally, offering a good home-cooked meal is seen as an essential part of patient care, providing comfort and nutrition.
Implementation Challenges and Solutions
Dr. Susanta Svend from SNO, Odisha, highlighted the challenges of implementing healthcare programs in district hospitals, especially in rural areas. The key issues include staffing of physicians and pediatricians and capacity building for medical officers to manage extra work, such as chemotherapy.
Incentives and Career Opportunities
Incentives play a crucial role in retaining medical professionals in district hospitals. However, financial incentives alone may not suffice. Professional respect and career progression are equally important. Medical officers and nurses find satisfaction in their roles when they are respected and recognized as oncologists of their district. They enjoy the work and the connections they build with tertiary care hospital oncologists, facilitating patient referrals and drug procurement.
Odisha’s Comprehensive Cancer Care Plan
Odisha’s Comprehensive Cancer Care Plan offers small financial incentives, such as ₹7,000 for medical officers and ₹3,000 for nurses. While these amounts may not be significant, they contribute to the overall motivation. Training and career progression opportunities are essential for retention. Ensuring that trained professionals are not transferred out of their positions helps maintain continuity and build expertise.
THE MEDICAL BULLETIN
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