Affordable cancer care hospitals

Heavy consumption of tobacco, alcohol and red meat, as well as under-equipped healthcare facilities, have contributed to high levels of cancer in Assam, compared with other parts of north east India. The sixth poorest of India’s 28 states, Assam reports more than 30,000 new cases of cancer each year. Diagnosis and treatment have been hard to access, with hospitals relatively few and far between. Many patients face hilly terrain for hundreds of kilometres on roads that are prone to flooding and damage. The result: cancers are causing a disproportionately high number of premature deaths.

34,000 annual new cases of cancer in Assam

But the situation is changing. In 2021, Assam’s state government along with Tata Trusts, the philanthropic arm of Indian industrial conglomerate Tata, opened 10 specialist hospitals to treat 15,000 patients per year and there are several more in the pipeline.

The facilities will help save thousands of lives in India’s sixth poorest state

Getting the best care

Tata Trusts and the Government of Assam wanted to achieve a state-wide ‘grid’ of facilities to provide affordable cancer care, initially with the aim of increasing the state’s diagnostic and treatment capacity by 150%. We led the master-planning and project design, starting with the identification of the right locations for the new hospitals.

A research and treatment complex at Guwahati, designated in the project as ‘level 1’, is the ‘hub’ of the hospitals network. Meanwhile, three ‘level 2’ comprehensive care centres have been built at Dibrugarh, Barpeta and Silchar, as well as six ‘level 3’ diagnostic and daycare centres at Darrang, Jorhat, Lakhimpur, Tezpur, Kokrajhar and Diphu.

We wanted to maximise the quantity and quality of healthcare that could be obtained with the available budget of Rs10bn (£100M). “Although the ‘hub’ facility has a bespoke design, we developed standardised solutions for the level 2 and 3 centres, and guided procurement for all 10 facilities together,” says our project principal, Amit Kumar.

The cancer hospitals programme includes three different levels of facility

The construction contract was won by India’s largest design and build contractor, Larson & Toubro (L&T), which brought its size, renowned technical skills and experience to realise efficiencies of scale. Our design, involving standardisation and innovation, enabled L&T to achieve an impressive 20% cost saving across the programme.

Modern methods of construction

Assam is in India’s most active seismic zone. To achieve the required seismic performance, we designed the facilities with isolated base foundations, meaning there is a degree of free movement between the ground and superstructure, protecting the buildings from the full force of tremors. This enabled the total amount of reinforcement to be reduced by between 15% and 20%.

The level 2 and 3 facilities were ‘prototyped’ at Barpeta and Goalpara, where sites became available earlier than the rest. “This enabled us to refine the designs for constructability, commissioning and handover,” says Amit. “While minor changes were required to suit local conditions, the exercise greatly reduced additional design time and simplified the delivery of groundworks.”

Our design incorporated the same mechanical, electrical and plumbing units – including lifts, escalators, heating/cooling, ventilation and associated plant – in all 10 buildings. This enabled L&T to procure for all the facilities under one contract. Steel reinforcement was also bought centrally.

L&T introduced construction equipment and methods not used in Assam before: state of the art falsework and formwork (scaffolding and shuttering for access and concrete pouring), cranes, and concrete mixing, pumping and monitoring equipment. Local workers received technical and health and safety training and were equipped with full personal protective equipment. After rapidly learning the necessary operating methods, they worked at speed and to a level of quality that set high new standards for Assam. “Other contractors have taken note and begun to follow the example set by this programme,” says Amit.

Life saving facilities

Further standardisation, combined with learnings and refinements achieved on the 10 new cancer treatment facilities, are enabling the next seven centres – also designed by us – to be delivered even more cost effectively, enabling more of Assam’s citizens to access cancer diagnosis, treatment and care.

7 further centres will now be delivered

Not only has the design and build of these centres led the way for Assam’s construction industry, but the new facilities have also been kitted out with world class medical equipment, procured by Tata Trusts. It includes the first computerised tomography and 360° positron emission tomography scanners in the state, as well as the latest radio and chemotherapy treatments.

Although the fight against cancer requires preventative measures such as lifestyle changes alongside further efforts to tackle poverty, the new facilities provide a major new means of catching cancers early and treating them appropriately. They will be lifesaving for many thousands of people.

The new centres feature world class medical equipment, such as positron emission tomography scanners