Lead Story. Cancer care goes free for the poor in Kerala

“We have two options, medically and emotionally: give up or fight like hell,” Lance Armstrong, champion cycle racer, who recovered from advanced testicular cancer once said about his battle against cancer. The American, fortunately, had the money to pay for the extremely expensive treatment. But, for the majority of 1.75 lakh people with cancer in Kerala, advanced treatment is not an affordable option. The cost of medicines, doctor consultations and diagnostic tests make treatment very expensive.

However, with the launch of the ambitious ‘ Sukrutham ’ initiative for free cancer treatment on November 1, the State’s birthday, the Kerala Government aims to take advanced cancer treatment to the poorest of the poor.

The free treatment, presently available at five Government medical college hospitals and three other hospitals, will later be extended to all 14 district hospitals. Those holding BPL (below-poverty line) cards as well as those covered by the Rashtriya Swasthya Suraksha Yojna , the national health insurance scheme, are eligible, for now.

Chief Minister Oommen Chandy says the Government wants to ultimately provide free cancer treatment to all those who need. In phase three of Sukrutham , free education will be provided to children with cancer.

Union Health Minister Harsh Vardhan, praising Sukrutham , said it would be replicated across the country by including it in the 13{+t}{+h} five-year plan.

The Government will supply drugs and consumables to the eight hospitals under the Sukrutham scheme.

And a corpus fund will be created at each of these hospitals to meet recurring expenses and maintenance of equipment, especially the linear accelerator, which is used for external-beam radiation therapy.

A Kerala Cancer Care Society (KCCS), with the CM as its head, is being set up to raise funds and channel them to the hospitals.

“This is the first time that a State Government is attempting to provide free cancer treatment in the country,” Health Secretary K. Elangovan told BusinessLine . “We know that this is an ambitious programme that will require huge funds.”

The cost of the programme is daunting, especially at a time when the Government’s financial health is pretty poor. “But, there is no other option—the number of persons with cancer is rising alarmingly every year.” The number of people with cancer is rising by around 35,000 every year—mainly oral and lung cancers among men and breast and cervical cancers among women.

Elangovan said the Government was exploring several avenues to fund Sukrutham . The new cess on cigarettes and a share of Karunya Benevolent Fund (earnings from the Government-run lottery business) would be utilised. “We also have this idea of charging ₹10 a month from mobile phone subscribers with the consent of the subscribers and the telecom service providers,” Elangovan said. CSR funding and NRI contributions would also be sourced through KCCS.

Dr M Beena, principal secretary in the Health Department, said the annual expenditure of the scheme would be upwards of ₹250 crores. “We will have to find a substantial share of this from non-Governmental sources,” she noted. The average expenditure on a patient, even at the highly reduced cost at Government facilities, would be around ₹50,000.

“The sustainability of the scheme is highly doubtful,” said Dr. B Ekbal, neurosurgeon, people’s health movement campaigner and former Kerala University Vice-Chancellor. “From where will the Government find money to pay for the exorbitantly priced cancer drugs made by multinationals?” he wondered.

For instance, Bayer’s advanced kidney cancer drug Nexavar (sorafenib tosylate) initially cost ₹2.8 lakh for a month, while its generically similar versions from Cipla and Natco were pegged at about ₹27,900 and ₹8,800 respectively. In fact, Cipla later slashed prices to about ₹6,800.

“But, when I think of the poor patients, I earnestly hope the Sukrutham scheme will survive,” says Dr Ekbal.

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