Guidelines for Strengthening of Tertiary Care of Cancer under National Program for Prevention and Control of Cancer, Diabetes, CVD & Stroke (NPCDCS) in 12th Five Year Plan (2012-17)

Objectives

The framework aims to expand equitable, comprehensive tertiary cancer care during India’s Twelfth Five-Year Plan (2012–17) by developing State Cancer Institutes (SCIs) and Tertiary Care Cancer Centres (TCCCs) under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.[1]It seeks universal access to cancer diagnosis, treatment and care, including prevention, early detection, referral, after-care, palliative care, rehabilitation and affordable services for poorer patients.[2][3]

• Establish 20 SCIs, intended as apex State or regional cancer institutions, and strengthen 50 TCCCs across government medical colleges, hospitals, institutes and former Regional Cancer Centres.[1][4]
• Develop SCIs as state-of-the-art institutions with at least 100 dedicated cancer beds and functional medical, radiation and surgical oncology departments, while developing TCCCs as facilities with at least 50 cancer beds and relevant clinical departments.[5][4]
• Provide comprehensive specialist services spanning pathology, imaging, surgical oncology, medical oncology, paediatric oncology, radiotherapy, radiation physics, anaesthesiology, chemotherapy day care, palliative care, rehabilitation, cancer registry and medical-record functions.[6][7]
• Strengthen SCIs’ role as repositories of State-level cancer knowledge, expertise and capacity, including protocol development, research, workforce development, teaching and community-oriented training.[1][2][7]
• Enhance regional referral capacity for difficult cancer cases, peripheral outreach, pain and palliative care, and coordination with medical colleges, non-governmental organisations and the wider health system.[3]
• Promote cancer epidemiology, basic and clinical research, cancer registry participation, prevention activities and screening-linked tertiary care.[2][7]

Implementation

Implementation is based on upgrading eligible existing institutions through State-sponsored applications, needs assessment, central appraisal and one-time capital assistance.[5][8]SCIs operate as nodal apex institutions that mentor TCCCs, government facilities and district-level cancer activities, while TCCCs provide outreach, mentoring and referral functions within their service areas.[2][4]

• Limit eligibility principally to government medical colleges and hospitals, former Regional Cancer Centres, autonomous public institutions and eligible experienced non-governmental Regional Cancer Centres or cancer-treatment institutions; institutions seeking SCI status normally require at least five years’ cancer-treatment experience.[5][9]
• Assess proposals against cancer prevalence, existing services, patient loads, specialist workforce, institutional and State capacity, land availability, financial soundness, State co-financing commitments and capacity to meet recurrent costs.[5][4]
• Require applicants to submit infrastructure, bed, service, equipment, staffing, patient-load, previous-grant and utilisation-certificate information, alongside a staged action plan and Gantt chart for equipment procurement, construction or renovation and service development.[6][7][9]
• Support radiotherapy, diagnostic, surgical, medical oncology, pathology, imaging, nuclear medicine and other cancer-care equipment; support inpatient facilities, construction or renovation, and other approved diagnosis, treatment and care activities.[5][2][10]
• Require regulatory documentation for radiotherapy proposals, including in-principle approval from the Atomic Energy Regulatory Board or relevant State undertaking where applicable.[3][7]
• Channel proposals and approved assistance through State or Union Territory Governments, with Ministry of Health and Family Welfare examination, central inspection where required, expert or Standing Committee consideration, and a tripartite memorandum of understanding between the institution, State Government and Ministry before release of assistance.[5][8]
• Apply transparent procurement procedures under applicable rules and require Ministry approval for equipment purchases based on assessed requirements; institutions or States bear expenditure above centrally advised equipment ceiling prices.[2][10]
• Provide free treatment to patients below the poverty line through a State-determined minimum number of beds, maintain reasonable approved user charges for other poor patients, and allow cross-subsidisation from patients able to pay.[2][8]
• Require States or institutions to meet recurring expenditure for personnel, maintenance, drugs for patients below the poverty line and other ongoing service costs; annual maintenance costs may be included in equipment orders for a reasonable period.[2][4]
• Monitor accountability through inspections, application appraisal, procurement approvals, grant-condition compliance, utilisation certificates, grant-fund management under applicable financial rules and State oversight of free-treatment and cancer-bed commitments.[8][9][10]
• Record institutional activity through data on beds, populations served, expected and registered cancer cases, surgeries, chemotherapy, teaching, research, palliative care and registry activity; the material does not specify a detailed outcome-evaluation framework, reporting frequency or quantitative performance targets.[6][7]

Monitoring & Evaluation

Monitoring and accountability are primarily embedded in proposal appraisal, inspection, financial controls and institutional reporting rather than a formal results-based evaluation system. Applicants provide baseline information on infrastructure, cancer services, patient loads, human resources, land, financial capacity, equipment needs and implementation plans, enabling assessment of institutional readiness and service gaps.[5][6][7]

• Assess eligibility and proposed investments against cancer prevalence, existing facilities, trained personnel, institutional and State implementation capacity, land availability, State financial commitments and capacity to meet recurring expenditure.[4]
• Undertake central inspection using prescribed assessment and inspection formats, with inspection reports recording the institution, dates, team details, checklist findings and a recommendation to approve or reject the proposal.[8][10]
• Require Ministry of Health and Family Welfare review and approval of equipment purchases based on assessed needs, with procurement conducted under applicable rules and procedures.[2][4]
• Track implementation stages through Gantt charts and supporting documentation on equipment, building plans, staffing, regulatory approvals and previous grants.[7]
• Record service and institutional activity through data on beds, populations served, expected and registered cancer cases, surgeries, chemotherapy patients, teaching capacity, publications, palliative-care activity and cancer-registry activity.[6][7]
• Require participation in the National Cancer Registry Programme of the Indian Council of Medical Research, with institutions undertaking cancer registration from their own resources.[2][8]
• Monitor access commitments through State Government responsibility for free treatment and designated cancer-care beds for patients below the poverty line, alongside compliance with Government of India grant conditions.[9]
• Require utilisation certificates within one year, documenting expenditure for the sanctioned purpose, treatment of unspent balances and fulfilment of grant conditions; institutions must maintain grant funds in a bank account in accordance with applicable financial rules.[8][10]
• Hold institutions and State Governments responsible for costs above centrally advised equipment ceiling prices, with the commitment included in the application.[2]

The available material does not specify quantitative outcome targets, standard indicator definitions, reporting frequency, surveillance targets, independent evaluation arrangements or a detailed evaluation methodology beyond the registry, application data, inspection and utilisation-certification mechanisms.[1][2][6][7]

Costing & Financing

The scheme provides one-time capital assistance for State Cancer Institutes and Tertiary Care Cancer Centres, financed jointly by the Central and State Governments, while States or institutions retain responsibility for land, recurrent expenditure and costs exceeding approved equipment ceilings.[5][4][8]

• Provide maximum assistance of 120 crore Indian rupees per State Cancer Institute and 45 crore Indian rupees per Tertiary Care Cancer Centre, inclusive of the State contribution.[5]
• Finance approved grants at a 75:25 Central Government-to-State ratio, with a 90:10 ratio for north-eastern and hilly regions.[8]
• Permit up to 30% of sanctioned assistance for civil and electrical works, construction, renovation and infrastructure improvement.[5][4][8]
• Release financial assistance through State Governments, with up to 75% of the Government of India share potentially released at sanction and the balance after procurement or construction is finalised; release modalities may be altered with ministerial approval.[2]
• Require the State Government or institution to provide land at its own cost, excluding land costs from the State share.[5]
• Require institutions or State Governments to meet recurrent costs for human resources, equipment maintenance, other facilities and drugs for patients below the poverty line; no recurrent grant is provided.[4][8]
• Permit annual maintenance costs to be included in equipment orders for a reasonable period.[5][2]
• Require States or institutions to finance expenditure above applicable Government of India equipment ceiling prices.[8][10]

The material does not specify total programme expenditure, annual budget allocations, a disbursement timetable beyond the stated release mechanism, quantified funding gaps, economic assumptions or a wider resource-mobilisation strategy.[1][2][7][9]