Cancer Care Access in Vidarbha: Gaps in Screening and Treatment in Rural Districts

thenewsdirt
May 8
7 min read

The road to accessing timely cancer care in India’s rural districts is shaped by distance, resources, and design.

In Chandrapur and Yavatmal, the state's cancer screening programme is in place and the hospitals are operational, but public health workers face challenges that go beyond infrastructure.

These districts in the Vidarbha region offer a closer look at what cancer care looks like in practice, who can access it, where gaps persist, and how far health services have travelled to reach the people.

Availability of Screening and Trained Staff in Government Centres

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) provides screening for oral, cervical, and breast cancers for adults aged 30 and above.

These services are offered through government-run Primary Health Centres (PHCs) and Health and Wellness Centres (HWCs), which have been upgraded under the Ayushman Bharat scheme.

The screening methods used under the programme include visual inspection with acetic acid (VIA) for cervical cancer, clinical breast examinations (CBEs) for breast cancer, and oral cavity checks for oral cancers.

These methods are simple and inexpensive, allowing screenings to be done by trained medical officers or nurses with minimal equipment. Each PHC is expected to carry essential supplies such as acetic acid, speculums, and light sources, while staff are trained to conduct and interpret basic examinations.

Across Maharashtra, over 11,000 Ayushman Arogya Mandirs (HWCs) are now operational, and the state reports a substantial number of trained personnel, including ASHAs and community health officers.

In Chandrapur and Yavatmal, district-level health authorities have rolled out the cancer screening programme through these centres.

However, data from the National Family Health Survey (NFHS-5) points to low participation rates.

In Maharashtra, only around 2.8% of women aged 30 to 49 had ever undergone cervical screening, and the rates in rural districts like Yavatmal and Chandrapur are estimated to be even lower.

Although screening infrastructure is in place, it remains underutilised.

Healthcare workers such as ASHAs and Auxiliary Nurse Midwives (ANMs) have been involved in mobilising patients for screenings. Special drives around World Cancer Day and other campaigns have increased footfall, but consistent community participation is yet to be achieved.

Training has been provided to many medical officers and nurses in these districts. The screening services are technically available, but daily execution depends on staff availability, patient awareness, and community outreach. While the equipment is simple and the processes straightforward, the primary barrier appears to be awareness and follow-up participation, not supply or training alone.

Diagnosis, Treatment and Referral Pathways

Once a screening result is positive or suspicious, patients are referred to a higher-level facility for diagnosis.

District hospitals serve as the next step, where gynaecologists and surgeons can perform biopsies, and pathology services are available.

In Yavatmal, the Government Medical College Hospital provides such services. In Chandrapur, similar diagnostic follow-ups are handled at the district hospital, with some samples being sent to nearby cities like Nagpur or Wardha if local processing is unavailable.

Mammograms and Pap smears are not typically part of the service at PHCs. Mammography machines are only found in larger facilities, while Pap smear kits, though available in some community centres, are limited by laboratory capacity. VIA and CBEs remain the most practical first line of screening in rural health setups.

Until recently, patients in Chandrapur and Yavatmal who needed chemotherapy or radiotherapy had to travel to Nagpur or beyond. Long journeys, additional expenses, and delays in scheduling contributed to low compliance with treatment plans.

To address this, Chandrapur saw the launch of a day-care chemotherapy centre in 2022. It was set up through a collaboration between Tata Trusts, the Government of Maharashtra, and the Chandrapur Cancer Care Foundation.

This eight-bed facility within the Government Medical College Hospital now provides chemotherapy drugs, treatment services, and medical personnel. The facility operates during daytime hours and is free for patients, thanks to Tata Trusts’ support.

This centre also functions as a referral base for patients from Yavatmal and Gadchiroli, as it is closer than travelling to Nagpur.

A full-fledged 140-bed cancer hospital is also under construction in Chandrapur, designed to offer surgical, radiation, and intensive care once completed.

In Yavatmal, the Government Medical College Hospital handles some cancer-related surgeries and basic chemotherapy. However, a dedicated cancer treatment centre is yet to be established. Patients requiring radiotherapy still have to travel outside the district.

For those under government insurance schemes such as Ayushman Bharat and the Mahatma Phule Jan Arogya Yojana, cancer treatment is theoretically free at empanelled centres. Yet patients face indirect costs, travel, lodging, missed wages, which are not covered by these schemes.

Cancer Burden and Community-Level Challenges

The regional burden of cancer is concentrated around a few types. A study from the Regional Cancer Hospital in Nagpur shows that among men in Vidarbha, over half of all diagnosed cancers are oral, largely due to high tobacco consumption.

Among women, breast and cervical cancers top the list. The same study estimates that oral cancer accounts for about 15% of female cases as well.

In Chandrapur and Yavatmal, the patterns are similar. Health authorities report that oral, cervical, and breast cancers are the most commonly diagnosed. District-level screenings conducted under NPCDCS and special medical camps have confirmed this trend.

One such mega-camp in 2019 in Chandrapur, organised through corporate partnerships, screened over 10,000 people, revealing a significant number of oral lesions and gynaecological abnormalities.

Tobacco use in these districts is widespread, particularly in chewing form. Awareness of oral cancer symptoms remains low, especially among male users. Similarly, many women in rural communities are unaware of the need for breast and cervical screening. Cultural discomfort with physical examinations, especially when male providers are involved, adds another layer of hesitation.

Screening uptake is also limited by logistical issues. While the state provides equipment and staff, actual implementation depends on outreach. In many villages, cancer screening is only promoted during specific health days or community mobilisation events. Outside of these efforts, awareness levels remain minimal.

Even after a positive screening result, follow-through is inconsistent. Patients often fail to report for follow-up diagnosis. Travel requirements, fear of diagnosis, and financial constraints play a role. The health system lacks a robust tracking mechanism to ensure positive-screened individuals are re-contacted and supported through their next steps.

The timing of diagnosis is a concern as well. Healthcare providers note that many patients present with advanced-stage cancers.

Women with large breast lumps or men with long-standing oral ulcers often arrive only after symptoms become painful or obstructive. By this time, treatment is more invasive and outcomes are poorer.

Partnerships and Systemic Barriers

Efforts to close these gaps are underway through public-private partnerships. The Tata Trusts’ involvement in Chandrapur’s cancer care infrastructure is a major milestone.

Apart from constructing the day-care facility, they have provided staff, chemotherapy drugs, and capacity-building for local teams. The full-scale hospital under construction aims to serve not just Chandrapur but also surrounding districts.

Other contributors include NGOs and corporate entities. Western Coalfields Limited, operating in Chandrapur, has organised medical camps that include cancer screening. ACC Trust partnered with the Ratna Nidhi Charitable Trust in 2019 to run a multi-district medical camp. In Yavatmal, local NGOs have conducted breast cancer awareness workshops, targeting early detection and education.

Mobile screening vans operated by groups like Rotary International have also visited interior villages in these districts.

These vehicles carry mammography equipment and trained technicians to perform on-the-spot tests, helping bridge the access gap. However, their visits are occasional and do not substitute for ongoing services.

Despite these initiatives, several systemic challenges persist. First, there is a shortage of specialised personnel. Oncologists and radiotherapists are still concentrated in urban centres like Nagpur. Secondly, pathology services are limited. Delays in biopsy reports can prevent treatment from starting on time.

In addition, referral systems are loosely coordinated. A PHC might identify a case, but there is no guarantee that the patient will navigate to the right hospital, be scheduled for evaluation, or complete the prescribed treatment. Medical officers often lack the bandwidth to track every case once it leaves their facility.

Government insurance schemes are present but not fully understood by patients. Many eligible individuals are unaware of the benefits or do not know how to enrol. Others face difficulties completing the paperwork or providing the documentation required for free treatment.

Gender and social dynamics also play a role. Women in rural areas often need spousal or family approval to seek medical care. Travel alone or with young children is difficult, and multiple hospital visits are often unfeasible. Men engaged in daily-wage labour may delay seeking care due to fear of income loss.

The presence of cancer screening and treatment services does not always translate to their use.

Awareness, affordability, and coordination remain the deciding factors for access in districts like Chandrapur and Yavatmal. The state’s programme, supported by NGO initiatives and private partnerships, continues to expand, but significant portions of the population still lack early and complete cancer care.