Comprehensive value-based cancer care in India: Opportunities for systems strengthening

Abstract

Cancer has been one of the leading causes of death in India in the past decade. The growing cancer burden has generated an unmet need to identify and address gaps in the healthcare system to enable access to affordable and quality cancer care for all in a manner that enhances the value of care. This paper provides an overview of the value-based care approach, identifies areas for enhancing the objectives of value-based care through multi-characteristic and multidimensional consideration of patient centricity and proposes health system strategies to improve comprehensive value-based care in India within the current context, focusing on implications for women’s cancers. The core characteristics of patient centricity – heterogeneity and complexity – are detailed to complement and expand on previously defined aspects of value-based care. Comprehensive value-based cancer care can serve as a test case and proof of concept for the rest of the health system in India and focusing on women’s cancers as a starting point can mandate attention to gender-responsive and transformative design and implementation.

Improving access to cancer care among rural populations in India: Development of a validated tool for health system capacity assessment

“…Moreover, a wide range of respondents relevant to cancer services delivery are involved in the completion of this HSCA tool. This pursues the goal to advance value‐based cancer control, that is, capitalizing on the value generated toward societal well‐being 42,45 . Many examples of policy levers to enhance the health system's value 46 are explored through the ACCI HSCA tool.…”

“…Once the information is collected through facility visits, the in‐depth interviews delve into the gaps identified in coordination of services and provision of care, and aim to elucidate its drivers. Notably, the in‐depth interview guide addresses various foundational shortcomings that have already been described in the literature in relation to PM‐JAY's plan to strengthen primary healthcare delivery through health and wellness clinics, such as inadequate budgetary allocations, inadequate infrastructure, lack of trained workforce, and weak coordination between the screening and early diagnosis programs and district health facilities 41–43 …”

“…Notably, the in-depth interview guide addresses various foundational shortcomings that have already been described in the literature in relation to PM-JAY's plan to strengthen primary healthcare delivery through health and wellness clinics, such as inadequate budgetary allocations, inadequate infrastructure, lack of trained workforce, and weak coordination between the screening and early diagnosis programs and district health facilities. [41][42][43] In recognition of the myriad of implementation barriers that exist toward accessing quality services for cancer control in India, the ACCI tool has also been developed in a pragmatic sense, in order to contextualize its use within the Indian healthcare system and identify actionable bottlenecks. Its pre-testing and revision process entailing national experts and key local stakeholders (Figure 1), which led to substantive item reduction, will facilitate its adoption by data collectors.…”

“…This pursues the goal to advance valuebased cancer control, that is, capitalizing on the value generated toward societal well-being. 42,45 Many examples of policy levers to enhance the health system's value 46 are explored through the ACCI HSCA tool. For instance, in terms of technical value (pursuing the achievement of the best possible outcomes with available resources), promoting adherence to clinical guidelines can improve evidence-based cancer care.…”

Understanding the Value of Alleviating Health-Related Suffering and Palliative Care Centered in Lived Experience: The SAVE Toolkit

“…2,3 Moreover, patient complexity in terms of the triple burden of the disease itself, healthcare navigation, and selfmanagement of care and the corresponding workload on patients 4 alongside heterogeneity in the patient experience 5 remain at the periphery of priority-setting and implementation. 6 Within this context, palliative care offers an opportunity to understand and increase the value generated from health care. Indeed, palliative care inherently applies a patient-centered approach with a focus on patient values, preferences, concerns, needs, and expectations to improve quality of life from point of diagnosis through the end of life.…”