National hub-and-spoke cancer networks with defined referral tiers
Instead of one overwhelmed national cancer hospital, organise care in tiers: district hospitals diagnose and give simple treatment, regional centres give chemotherapy and surgery, and the hub handles radiotherapy and complex cases.
Many LMICs have a single national cancer institute that patients travel days to reach, with everything else undefined. Formal networks with tiered service specifications, referral criteria, shared protocols, and a common minimum dataset (the Tata Memorial National Cancer Grid in India is the largest example) spread capacity, shorten travel, and make quality auditable. The design choices are which services sit at which tier and how the money follows the patient.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.
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