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 provides financial assistance during the Twelfth Five Year Plan, 2012 to 2017, under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke to establish and strengthen comprehensive tertiary cancer-care capacity.[1]It envisages 20 State Cancer Institutes and 50 Tertiary Care Cancer Centres across States and Union Territories.[1][2]

• Establish State Cancer Institutes as apex institutions for cancer knowledge, specialised expertise and capacity, able to coordinate and mentor tertiary institutions, government facilities and district-level cancer activities.[1][3]
• Strengthen Tertiary Care Cancer Centres in government medical colleges, hospitals, institutes, former Regional Cancer Centres and eligible district hospitals to provide tertiary services and outreach in their catchment areas.[4][2]
• Deliver comprehensive cancer prevention, early detection, diagnosis, treatment, aftercare, rehabilitation and palliative care, including referral management for difficult cases and pain relief with opioid availability.[5]
• Develop specialised service capacity in medical, radiation and surgical oncology, radiotherapy and brachytherapy, diagnostic imaging, nuclear medicine, pathology, cytology, histopathology, haematology, biochemistry, medical records and palliative care.[6][7]
• Improve access and affordability by providing free treatment and reserved beds for people below the poverty line according to State policy, while maintaining State-approved affordable charges for other poor patients and allowing cross-subsidisation from patients able to pay.[3][8][9]
• Strengthen outreach, screening-linked referral, treatment protocols, cancer registry participation, research, training and workforce development for doctors, nurses, technologists and technicians.[1][3][5]

The framework prioritises development of state and regional cancer-care infrastructure and institutional capability rather than setting quantified population-health outcomes, screening targets or cancer-control impact indicators.[1][6]

Implementation

Implementation is based on competitive institutional proposals endorsed by State or Union Territory Governments, technical scrutiny by the Ministry of Health and Family Welfare, and grant agreements among the institution, State Government and Government of India.[4][3][8]Existing government medical colleges, hospitals, autonomous public institutions, former Regional Cancer Centres and eligible experienced non-government institutions may receive support, subject to the applicable conditions.[4][3]

• Assess eligibility through specified service capacity, cancer-treatment experience, dedicated cancer beds, oncology departments, laboratories, staffing, land, financial viability and the ability of the State and institution to meet recurring expenditure.[4][2][9]
• Require applicants to submit an action plan covering equipment and, where necessary, construction separately, alongside infrastructure and manpower details, patient workload, previous grants and utilisation certificates, implementation Gantt charts, regulatory permissions and State funding commitments.[4][5][10][9]
• Use a four-part proforma covering institutional information, grant application and action plan, State recommendation and central inspection.[6]Proposals may be inspected by a central team, assessed by an expert team and referred to a Standing Committee before recommendation and approval.[4][8]
• Execute a tripartite Memorandum of Understanding between the grantee institution, State Government and Ministry of Health and Family Welfare before releasing assistance.[3][8]Release grants through the State Government, with up to 75% of the Government of India share available at sanction and the balance after procurement or construction is finalised, subject to permitted release arrangements.[3]
• Procure radiotherapy, diagnostic and surgical equipment, expand inpatient facilities and undertake related civil and electrical works, including renovation, according to assessed need, Ministry approval, applicable procurement rules and transparent procedures.[4][3][8]Equipment orders may include maintenance for a reasonable period.[4][3]
• Link supported centres with government prevention and screening programmes, cancer registry activities, training, research, referral pathways, peripheral outreach and mentoring arrangements.[3][5][8]
• Require States to provide their contribution, supply land at their own or the institution's cost, monitor grant utilisation and free-treatment commitments, and meet recurrent costs for staffing, maintenance, medicines and other operating needs.[4][2][9]
• Apply ceiling prices to specified costly equipment, with the institution or State Government financing any cost above the approved ceiling.[3][8][7]

Accountability mechanisms include State recommendation and underwriting, central inspection, procurement compliance, confirmation of actual grant use, utilisation certificates, and surrender or adjustment of unspent balances.[9][7]Grantee institutions must settle utilisation certificates within one year of grant sanction, manage grant interest under Government of India financial rules, and participate in the Indian Council of Medical Research National Cancer Registry Programme using their own resources.[8]The framework does not specify formal performance indicators, reporting frequency, independent evaluation methods or quantitative surveillance targets beyond application, inspection, registry and utilisation requirements.[3][6][9]

Monitoring & Evaluation

The framework relies on pre-award appraisal, central inspection, State Government oversight, utilisation certification and cancer-registry participation to assure appropriate use of assistance. It does not establish a comprehensive results framework with standardised outcome indicators, reporting frequencies, surveillance targets or independent evaluation methods.[4][3][8][9][7]

• Assess State Cancer Institute proposals against cancer prevalence, existing service capacity, trained personnel, institutional and State implementation capability, land availability, State co-financing and ability to sustain recurring costs.[2]
• Assess Tertiary Care Cancer Centre proposals against State Government recommendations, existing cancer-care facilities and the capacity of the institution or State to deliver proposed activities.[2]
• Examine proposals through the Ministry of Health and Family Welfare, using central-team inspection where warranted, before referring technically suitable applications to a Standing Committee for appraisal and recommendation.[4][8]
• Use a structured proforma and inspection process to document infrastructure, beds, services, staffing, patient coverage, equipment, construction status, regulatory approvals, previous grants and utilisation certificates.[6][10]
• Record coverage populations and districts, expected annual cancer cases, new registered cases, user charges, cancer surgeries, chemotherapy patients, teaching, research, training, palliative care and registry activities.[6][10]
• Require State Governments and institutions to ensure transparent procurement, comply with equipment price ceilings, meet commitments in applications and assistance arrangements, and monitor grant utilisation and free treatment provision.[3][9]
• Require grantee institutions to submit previous-grant information and utilisation certificates, settle the utilisation certificate within one year of grant sanction, and certify that funds were used for approved purposes, unspent balances surrendered or adjusted, conditions fulfilled and actual use verified.[5][8][7]
• Require institutions to undertake cancer registry activities and participate in the Indian Council of Medical Research National Cancer Registry Programme using their own resources.[8]
• Manage grant funds through a bank account and handle accrued interest in accordance with the Government of India General Financial Rules and applicable instructions.[8]

Costing & Financing

Financing comprises one-time capital assistance for State Cancer Institutes and Tertiary Care Cancer Centres, shared between the Central and State Governments, while States or institutions remain responsible for land, recurrent expenditure and equipment costs above approved ceilings. No overall programme budget, annual allocation, funding-gap estimate, economic assumption or wider resource-mobilisation plan is specified.[4][3][2][8][9][7]

• Provide maximum one-time assistance of 120 crore Indian rupees for each State Cancer Institute and 45 crore Indian rupees for each Tertiary Care Cancer Centre, inclusive of the State contribution.[4][2][9]
• Finance approved grants at a 75:25 Central-State ratio, changing to 90:10 for North-Eastern and hilly regions.[8][9]
• Release up to 75% of the Government of India share at sanction and the remaining 25% after procurement or construction is finalised, subject to permitted changes in release arrangements.[3]
• Allow up to 30% of sanctioned assistance for construction, renovation, and associated civil and electrical works.[4][2][8]
• Require the State Government or institution to provide land at its own cost; land expenditure is excluded from the State share.[4]
• Require States or institutions to meet recurring expenditure, including human resources, equipment maintenance, other facilities and medicines for people below the poverty line; recurrent grants are not permitted.[2][8][9]
• Require the State Government or institution to meet equipment expenditure above Central Government ceiling prices, including for equipment costing more than 1 crore Indian rupees per unit.[3][7]
• Permit affordable State-approved user charges and cross-subsidisation from patients able to pay, while requiring free treatment for people below the poverty line in accordance with State policy.[3][8][9]