Innovations at scale only, capable of offering access to care solution: Example of district cancer care model (Pendharkar model).

19 Background: Sustainable development goals and voluntary global NCD targets 2025 plan to achieve 80% coverage by essential NCD medicines and technologies and drug therapy and counselling coverage to the tune of 50%. This can only be achieved by making coverage wider, going to periphery and urgently creating workforce capable of doing such an activity at scale. District cancer care model (Pendharkar model) tried to involve these principles and shown a scalable acceptance by the health system. Methods: To expand the access administratively, most peripheral but medically most suitable, district hospitals, were used to create nodal cancer units. To achieve the scale, all districts of a state were targeted. For creating an alternate workforce existing medical officers and nurses were utilised. Results: Over a period of 5 years seven states of India, having a population of more than 250 million, have agreed to join the programme.176 districts have created nodal cancer units with physician and two nurses in-charge of the programme. They delivery variety of care including counselling, chemotherapy, supportive, palliative, follow up care. They serve as nodal units for public education driving government programmes including public education. At least 300-500 patients avail the services on a daily basis, including more than 200 chemotherapy procedures in a day. On world cancer day educational activities happened in all these districts simultaneously creating massive impact. Conclusions: This unique innovative model has proven that health system changes can be brought at very large scale using existing government possibilities. Available infrastructure, human resource, minimal financial changes with administrative reforms can lead to impactful change in access to cancer care at scale.