Creating affordable and accessible cancer care at scale: History of extension from 12 to 750 districts, covering the whole of the nation—India.

e13599 Background: The principal challenges in cancer care are the affordability, accessibility, and availability of an adequately trained oncology workforce. In central India, a structured model of cancer care delivery was initiated in 2014 across 12 districts. This model is currently being scaled up to achieve nationwide coverage. We present how cancer care services achieved large-scale expansion through the optimization of existing health system infrastructure, systematic capacity building, task sharing, and the development of an alternative oncology workforce. Methods: Each district is served by a state-owned comprehensive district hospital, which provides free general medical services. An oncology capacity-building program targeting medical officers and nursing personnel was implemented, leading to the establishment of dedicated oncology units in each district hospital. In 2014, this program started with 12 districts. Now, it has grown to 200 districts in eight Indian states. The training methodology, documentation protocols, follow-up training procedures, and support mechanisms were standardized at all sites. A key feature of the program was the provision of continuous (24 × 7) professional backup to the entire oncology workforce. Simultaneously, the district-level essential medicines list was revised to include essential anticancer drugs. Results: In total, more than 200 districts participated, with over 296 physicians and 542 nurses trained (Table 1). The training program was complemented by on-site supervisory visits that included cancer-related service delivery activities in each district, short-term continuing medical education (CME) courses, and participation in scientific conferences. State-level WhatsApp groups facilitated routine communication and case-based discussions to support ongoing clinical decision-making. This implementation model contributed to health system strengthening through broad-based adoption, enhanced resilience during crises, and integration into governmental structures. Conclusions: The challenges of ensuring affordable and accessible cancer care have been substantially addressed through the district cancer care model. The Government of India has adopted it for national implementation. This model has the potential to alleviate financial toxicity and reduce the overall economic burden associated with cancer care and it addresses critical shortages in the oncology workforce. Thus, the district cancer care model may serve as a foundational framework for health systems worldwide. Training of oncology workforce. S.no Name of State Doctors Staff Nurse Year of Training 1 Madhya pradesh 90 240 2014 2 Odisha 28 56 2015 3 Rajasthan 33 66 2016 4 Gujarat 19 36 2017 5 Uttar Pradesh 15 30 2017 6 Himachal Pradesh 44 22 2017 7 Bihar 16 42 2017 8 Chattisgarh 45 44 2017 9 Haryana 6 6 2025 Total 296 542