India has one of the highest cancer mortality-to-incidence ratios globally. This is due to inadequate participation in screening programs, and the uneven distribution of healthcare resources between urban and rural areas:

Currently, only about 1% of the rural population is screened for key cancers (cervical, breast and oral cancer). Access to basic diagnostic tools like lab tests, blood work, and scans is still sparse in many rural areas (Source).

When it comes to seeking treatment, out of the 640 districts in India, only ~175 have a Comprehensive Care Centre, covering just 40% to 45% of the population. The remaining 55% to 60% of the rural population must travel or temporarily relocate outside their districts to receive treatment (Source).

The Abohar-Jodhpur Express, infamously dubbed as the “cancer train”, transports patients daily across 325km from Bhatinda to Bikane for treatments. Source: Tribune Photo

Under the Indian government’s flagship Ayushman Bharat Scheme, approximately 30,000 state-owned rural and urban healthcare facilities, known as “primary health centers,” are being upgraded to “Ayushman Bharat Health and Wellness Centres” to provide basic cancer screenings along with a range of primary health services.

In theory, these upgraded centers are intended to offer screening for oral, breast, and cervical cancers by trained staff. However, in practice, these centers face significant challenges, including the existence of ghost centers and the absence of medical professionals.

An empty desolate room stands where an Ayushman Bharat Health and Wellness Centres was supposed to have come up in Bhalivadi village. Source: Scroll.in

In a report by NITI Aayog, the government’s policy think tank, out of the 93 Health and Wellness Centres visited by their team, fewer than 10% had completed a single round of non-communicable disease screening, including cancer, despite being operational for over a year. This shortfall is largely due to a shortage of trained staff, absenteeism of healthcare workers in rural areas, and a lack of equipment, including facilities for cervical cancer testing, primarily due to insufficient funding.

As for the private players, in response to the growing demand, both large multi-specialty hospital chains and single-specialty oncology providers, such as Healthcare Global Enterprises Limited (HCG), have pledged to deepen their reach into Tier II and III cities. Many have adopted a hub-and-spoke model, establishing a network of healthcare facilities that provide basic services including chemotherapy, in smaller daycare centers in these cities. Patients requiring intensive treatments, like radiation therapy, are referred to a central hub facility.

HCG Day Care Center in Malleshwaram, Bangalore

Achieving penetration into rural communities and ensuring quality, efficient care is not easy,due to the complexities involved in adapting large hospital operations to smaller, more streamlined centers in these areas. There remains a substantial gap that newer players in the space may be well-positioned to fill.

Challenges in extending cancer care beyond the cities:

1. Building a Multidisciplinary Team  

Effective cancer care necessitates oncologists across multiple specialties and functional expertise, along with a strong clinical support team (nurses, pharmacists, radiologists). This becomes more challenging in rural areas as qualified doctors often migrate to urban cities for better economic opportunities. Sustaining a multidisciplinary team in rural settings requires identifying a team that is committed to grassroots impact, aligning with their personal and professional goals, and offering the right incentives. This requires a leadership team that deeply understands these professionals, possesses significant influence, and has earned their trust

Oncologist, technician, physicist shortages today in India. Source: EY

Establishing a comprehensive cancer treatment facility is expensive. There are three main modalities in cancer treatment: surgery, chemotherapy, and radiation therapy. Of the three, radiation therapy requires the maximum investment and dedicated infrastructure. Imported radiation therapy equipment, such as Linear Accelerators and CyberKnives, costs approximately 11 Crore INR and 30 Crore INR, respectively. Yet, for the most common cancers, such as breast and cervical cancer, the majority of patients have found to have localised disease when diagnosed, where the primary definitive treatment is radiation therapy.

Doctors estimate that a 100-bed cancer specialty hospital would require an investment of 100 Crore INR (USD 12M), excluding land costs. A step-wise approach that carefully balances return on investments is important. One way is by partnering with hospitals to leverage their equipment and treatment facilities, i.e. using a “shop in shop” model, before gathering sufficient patient traffic to justify their own capital expenditures.

In rural India, a significant portion of patients rely on both public and private insurance to cover the costs of their treatments. The ability of providers to navigate through a range of insurance options is crucial for enabling cashless and frictionless treatment, especially when there are variations among the states in terms of procedures excluded from insurance coverage (e.g., genomics, targeted therapy, and immunotherapy). Providers must also deal with patients who may be in a stressed mental state. Ensuring an individualised treatment strategy based on the patient’s financial and psychological status is essential to achieve high treatment completion rates and prevent inappropriate treatment.

MVP first invested in CION Cancer Clinics in 2020, recognising the potential of their care delivery model - an asset-light, hospital-in-hospital arrangement to establish structured networks of care touch points. This approach has enabled them to effectively extend services to areas traditionally underserved.

The founders, Sonali Srungaram and Sasi Sunkara , are driven and high-caliber individuals. Notably, the team previously initiated India’s first cancer helpline, which assisted 45,000 patients across eight languages within two years. This endeavour highlighted a critical gap: while 90% of the cancer population resides outside urban areas, the majority of infrastructure is urban-focused. This realisation inspired their journey to build CION. Since MVP's initial engagement, Sonali and Sasi have consistently demonstrated their commitment and capacity to navigate the complexities of the healthcare sector. With a dedicated team at the helm, CION aims to make quality cancer care accessible to all, especially those in areas where it was previously out of reach.

This investment reflects our broader commitment to supporting solutions that address significant healthcare disparities and contribute to a more equitable healthcare landscape in India, ensuring that quality cancer care is within reach for all.

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Disclaimer: The views expressed in this article are those of the individual authors and do not necessarily reflect the views of M Venture Partners (MVP) or its affiliates. Information presented here may have been obtained from third-party sources deemed reliable; however, MVP has not independently verified this information and makes no representations about its accuracy or suitability for any purpose. This content is provided for informational purposes only and should not be construed as legal, business, investment, or tax advice. Readers are encouraged to consult with their own advisors before making any decisions. Investments mentioned may not be representative of all investments made by MVP, and there is no guarantee of future results.