The Role of Businesses in Supporting Non-Governmental Organisation for Cancer Care in India: Priorities, Barriers, and Facilitators

The Role of Businesses in Supporting Non-Governmental Organisation for Cancer Care in India: Priorities, Barriers, and Facilitators | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role of Businesses in Supporting Non-Governmental Organisation for Cancer Care in India: Priorities, Barriers, and Facilitators Pooja Sharma, Ojaswi Phal Desai, Vid Karmakar, Parth Sharma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8256379/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract PURPOSE Over 75% of Indian households affected by cancer face catastrophic health costs. Support from non-governmental organisations (NGOs) and corporate philanthropy, through initiatives such as Corporate Social Responsibility (CSR), which involves corporate funding for social development, helps address health disparities. This study explored factors influencing CSR spending on cancer projects and associated barriers and facilitators. METHODS In-depth semi-structured interviews were conducted with 15 NGO and 3 CSR stakeholders. Data were thematically analyzed using an inductive approach until saturation was reached. RESULTS Participants indicated that CSR funding for cancer initiatives was affected by four factors: 1) misalignment between corporate priorities and NGO cancer care needs, 2) neglect of NGOs’ operational and capacity-building costs, 3) businesses’ preference for initiatives in their close vicinity, and 4) outcomes of the diseases. NGOs seeking CSR funding for cancer care faced barriers, including limited attention to sustainability and long-term impact; limited organisational capacity to meet communication, reporting, and administrative demands of CSR grants; and the competitive disadvantage of small or grassroot NGOs versus larger, well-established organisations. Despite these challenges, participants identified facilitators and opportunities to enhance CSR’s impact, such as adopting innovative partnership models between corporates and NGOs, extending CSR support to non-medical care costs like lodging, educational outreach and nutritional assistance, and fostering collaborations where established NGOs share CSR funds or expertise to support smaller organisations in joint cancer care projects and a tendency for companies to contribute when leaders or staff had personal or family experiences with cancer. CONCLUSION This is the first qualitative study to highlight the determinants, barriers, and facilitators of CSR spending on cancer care in India. While India’s mandatory CSR legislation has increased investment in social development, its full potential in cancer care remains untapped. Oncology 1. INTRODUCTION Cancer is a leading cause of morbidity and mortality globally ( 1 ) . In low- and middle-income countries (LMICs), cancer treatment imposes a high financial burden on patients and their families ( 2 ) . This burden manifests in several ways, including direct medical costs for diagnosis, treatment, hospitalization, etc; non-medical costs for transportation, accommodation, food, and indirect costs due to loss of income and productivity ( 3 ) . To meet these expenses, patients with cancer and their families frequently incur high out-of-pocket expenditures ( 4 ) . In 2017, more than 75% of households in India affected by cancer experienced catastrophic expenditures to meet the costs of treatment ( 5 ) . India introduced various public and private insurance to ease the financial burden on patients with cancer. However, the effectiveness of such measures remains limited due to scarce coverage, inconsistent implementation, and exclusion of outpatient expenditures ( 6 , 7 ) . Additionally, public health expenditure in India has remained below 2% of the Gross Domestic Product (GDP) ( 8 ) . Due to this, patients with cancer face a dual burden: public hospitals lack advanced facilities due to low funding, while private hospitals, though better equipped, are unaffordable for most patients ( 9 ) . Efforts by various non-governmental organisations (NGOs) and philanthropic initiatives play an important role in alleviating such health disparities by bridging financial gaps ( 10 ) . For example, in India, the National Cancer Grid piloted a pooled procurement process for cancer and other supportive care medicines, thus reducing the cost of such drugs by 82% (11) . Another initiative at the Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, provides a ‘360 degree’ philanthropic support model for patients belonging to the pediatric age group ( 12 ) . The philanthropic model is supported by various sources, most notably through corporate social responsibility (CSR) contributions from public sector undertakings (PSUs) and corporations. Corporate social responsibility (CSR) in India is governed by Section 135 of the Companies Act, 2013. It mandates eligible companies to contribute to social welfare projects by investing 2% of their average net profit, based on the previous three consecutive financial years ( 13 ) . To qualify for CSR under the Companies Act 2013, a company must fulfill any one of the following criteria during the immediately preceding financial year: net worth of rupees five hundred crore or more, a turnover of rupees one thousand crore or more, or a net profit of rupees five crore or more ( 14 ) . CSR is implemented via a company-established trust/foundation, registered NGOs, or collaborations with other companies. Healthcare has been a major sector of investment, receiving nearly 26% of all the CSR funds in the financial year of 2020–2021 ( 15 ) . Numerous CSR initiatives target cancer care by funding new oncology hospitals, mobile screening units, patient lodgings, and awareness groups ( 16 ) . While CSR contributions to non-profit organisations have been imperative to support such cancer-specific programs ( 17 ) , there is a notable lack of research on how CSR and non-profits interact, how CSR funds are allocated to cancer-focused NGOs, how partnerships are formed and maintained, or what mutual expectations and constraints shape these collaborations. The primary objective of this study was to identify the factors that influence CSR spending on cancer projects. The study also aimed to report the hurdles that non-profit organisations face when accessing CSR funding and propose facilitators to increase CSR contribution to cancer care. By unraveling these aspects, the research aims to inform actionable insights of alleviating financial burdens by facilitating support for people undergoing cancer treatment in India and comparable low- and middle-income countries (LMICs). 2. METHODS 2.1 Study designs and participants We conducted a qualitative study using purposive and snowball sampling. Twenty-nine informants (22 NGO and 7 CSR representatives) across diverse institutions (established NGOs, specialised cancer care foundations, and corporate companies) and geographical locations, including urban and semi-urban organisations across 7 Indian states, were approached. This approach aimed to capture varied perspectives on the role of CSR funding along with the challenges it poses to cancer-related non-profit organisations. The study was approved by the Biomedical and Health Research Ethics Committee, Jehangir Clinical Development Centre Pvt. Ltd., with a waiver of ethical clearance granted as no patient or clinical data were involved (EC Registration No.: EC/NEW/INST/2023/MH/0236). 2.2 Data collection In-depth interviews were conducted in English and Hindi by two investigators (PoS and VK), who had no prior relationship with the participants, to minimize potential bias. Each interview began with an orientation outlining the study’s purpose, objectives, and ethical safeguards. A semi-structured interview guide (Supplementary file) was initially drafted by VK based on a review of existing literature on health philanthropy, civil society engagement, and corporate social responsibility (CSR) in healthcare. This guide was subsequently refined by PoS and reviewed by a co-author with expertise in qualitative research (PaS) to enhance its contextual relevance and content validity. The final guide included open-ended questions aimed at eliciting rich narratives regarding the organizations’ operational structures, funding priorities, decision-making processes, collaborative models, and perceived contributions to cancer care. Participants were purposively selected to include representatives of non-profit organizations that sought or received CSR funding, as well as CSR heads or senior representatives of corporate entities engaged in healthcare philanthropy. All interviews were conducted online between January and March 2025. Each session lasted approximately 45–60 minutes and was audio-recorded with the participant’s informed consent. Data collection continued until thematic saturation was achieved, defined as the point at which no new insights or themes emerged from successive interviews, determined jointly by the two investigators. 2.3 Data analysis One interview conducted in Hindi was manually translated and transcribed into English, while the remaining 17 interviews were transcribed in English using either the Zoom transcription function or Turboscribe software. All transcripts were manually reviewed and verified for accuracy by PoS. To maintain confidentiality, all identifying details were removed before analysis. Data were analyzed using Dedoose (version 10.0.25). A hybrid approach combining deductive and inductive thematic analysis was employed. Preliminary codes were developed deductively from theoretical frameworks on civil society participation, philanthropic capital, and health systems governance. Additional codes and subthemes emerged inductively through iterative reading of the transcripts. The analytic process proceeded in multiple stages. In the first phase, open coding was conducted to identify key concepts and recurring ideas relating to the motivations, constraints, and experiences of non-profit and corporate stakeholders. In the second phase, axial coding was performed to organize these codes into higher-order thematic categories such as strategic alignment, administrative challenges, accountability mechanisms, and partnership dynamics. The analysis remained iterative, with regular revisiting of transcripts to ensure that emergent themes were grounded in the data. To enhance analytic rigor, primary coding was undertaken by PoS and independently reviewed by VK for consistency and thematic completeness. A third researcher (PaS) subsequently reviewed the final coding framework to ensure conceptual accuracy and contextual coherence. Discrepancies were resolved through discussion and consensus among the research team. The entire analytic process adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure methodological transparency, reflexivity, and credibility of the findings. 3. RESULTS 3.1 Participant characteristics For this study, we interviewed participants from NGOs as well as corporate companies. The participants from the NGOs were either the founder members (n = 9) or the CEOs (n = 1), and in a few cases, the CSR leads (n = 5) employed by the NGOs. As for the corporate companies, we interviewed CSR heads (n = 3) engaged in funding cancer care projects. Data saturation was achieved after 18 interviews with participants of diverse backgrounds. The participants represented organisations involved in different areas of cancer care, like palliative care, pediatric cancers, cervical cancer, cancer genomics, cancer screening, awareness, and advocacy, and hailed from seven different states in India. 3.2 Themes Theme 1: Factors affecting CSR spending in cancer care This theme captures the divergent priorities of NGOs and corporate CSR representatives across three dimensions: type of services funded, geographic distribution of funding, and nature of support provided. While NGOs sought resources aligned with community needs, CSR representatives tended to prioritize projects that were measurable, visible, or demonstrated short-term impact. This misalignment often led to a gap between NGO needs and available CSR funding. 1.1 Difference in focus areas NGO representatives highlighted an incongruity between the services they provided and those that attracted CSR support. Preventive, screening, and awareness activities in cancer care received minimal attention ( Q1 , Table 1 ), and NGOs offering palliative care services struggled to secure funding, as companies often perceived such care as end-of-life support ( Q2 , Table 1 ). Table 1 Factors affecting CSR spending in cancer care Subtheme Supporting Quotes Difference in focus areas Q1 - ‘We do not feel that kind of work that we are doing in prevention primarily, and survivorship is of a lot of interest to more CSR. They are interested in either getting treatment for the individuals or getting health checkups and that sort of a thing. Rather than you know, talking about prevention, which is a lifestyle thing as well as vaccination, which I don't think we have the traction as yet.’ - [P9; CSR lead, NGO] Q2- ‘.....for us, it's just palliative care…that is way below cancer care… we are way down than cancer care. ‘ - [P11; CSR lead, NGO] Q3- ‘ So even if you talk with a lot of when I talk with a lot of hospitals, and I ask them, what is your requirement? They say, give me amount for heart, and then you give me amount for cancer. They will not ask amount for any other diseases, because per person expenditure for other diseases is quite low. It's maximum into cancer.’ - [P12; CSR head, Corporate company] Q4 - ‘Also, you will get more (funds) for cancer treatment. You will get less (funds) for cancer screening and awareness, right…. for cancer prevention. - [P5; CSR lead, NGO] Limited support for operational or capacity-building costs Q5- ‘But when it comes to CSR programs in these smaller tier 2 cities or other places they would prefer more of…They would be happy to give 100 wheelchairs and not support a salary of a physiotherapist. So that kind of a thing is still …that mindset is still there, and they would prefer to still do those one off events where they're gifting people something, or you know, or taking pictures. ’ - [P11; CSR lead, NGO] Bias toward urban or corporate-linked geographies Q6- ‘ Kerala has very limited CSR. Because, 1st of all, the location, not many. Most of the parent companies are in Hyderabad, Bangalore, Pune, Bombay, Delhi. So, and they would prefer to walk around their vicinities. And that's also that's something that CSR does. They prefer their own geographical locations and others.’ - [P11; CSR lead, NGO] Q7- ‘....there's a portion in the CSR Act which is interpreted wrongly by CSRs that they can support only within 45 kilometers of their head offices or manufacturing units. The line says that it is preferred that they support, but it does not say that it it has to be supported there. So, and you know, sometimes CSR managers do not. They are fixated on what the narrative is rather than what the possibilities are. So we lose lose out on many CSR because of the 45 kilometer range.’ - [P1; CEO, NGO] Q8- ‘ Unfortunately, maximum goes into Maharashtra, Karnataka Delhi. These States don't really have a need for CSR money. I mean, it's just that companies operate. They want to do something around their plants or their units. They want to be seen to be good corporate citizens, but that's not where the need is? The need actually is in these, in the northeast or in the aspirational districts.’ - [P7; Founder, NGO] Disease outcome dependent funding Q9- ‘I can tell you that it's much easier to draft CSR funding for pediatric cancer. One of the reasons for it… Couple of reasons, really, I mean, from what you anecdotally know, one is that recovery rate survival rate is much better in adults in children. Survival rate is better so. And that's again, that's something that we share with donors as well that you know, our rate is close to 70%. So that's appealing to many donors understandably.’ - [P2; CEO, NGO] Q10- ‘She gets more consideration the minute you say that they are children, and they can be treated, and we can give them a better life it is just a more emotional connect for us.’ - [P5; CSR lead, NGO] Q11 - ‘ it's a struggle to get funding for adult cancers. So it may be a larger cancer. But everybody thinks that, you know putting money into cancer is drowning it… There is nothing that comes out of it. We don't manage to save so many people so definitely in that way. It is not equitable.’ - [P5; CSR lead, NGO] Q12- ‘there is a wrong notion, especially in India that adult cancers are self-inflicted, due to smoking or tobacco, and so on. I mean, there is a notion not like anybody asks us. Nobody ever I mean… nobody really blames children for their condition.’ - [P2; CEO, NGO] CSR representatives, in contrast, were influenced by narratives of visibility, impact, and scalability. Hospitals often presented diagnostic and treatment-based interventions as high-impact opportunities, attracting greater CSR investment ( Q3–Q4 , Table 1 ). Consequently, initiatives such as lifestyle modification or vaccination, though essential, were overlooked due to their less tangible outcomes. 1.2 Limited support for operational or capacity-building costs NGOs reported persistent challenges in obtaining support for essential operational expenses, such as staff salaries and training. While these costs were crucial for service continuity, CSR funds rarely covered them. Corporates preferred donating visible assets, like medical equipment or infrastructure, where impact could be easily showcased ( Q5 , Table 1 ). This preference for tangibility left NGOs struggling to maintain personnel and facilities. 1.3 Bias toward urban or corporate-linked geographies CSR investments were reported to be heavily concentrated in metropolitan areas. Participants attributed this to logistical convenience and the misconception that CSR funds must be utilized within a fixed radius, often cited as 45 kilometers, of corporate operations ( Q6–Q7 , Table 1 ). This misunderstanding, combined with urban-centric preferences, left NGOs in rural and remote areas underfunded, despite their direct engagement with underserved communities ( Q8 , Table 1 ). 1.4 Disease outcome dependent funding A strong preference for funding pediatric cancer initiatives emerged, driven by higher survival rates and the emotional appeal associated with supporting children ( Q9–Q10 , Table 1 ). In contrast, adult cancer programs faced funding barriers, reflecting both lower survival prospects and a societal tendency to ascribe greater value to saving children’s lives ( Q11–Q12 , Table 1 ). This bias contributed to the inequitable allocation of CSR resources across different cancer types. Theme 2: Barriers faced by NGOs in mobilizing CSR funding This theme outlines the systemic, administrative, and communication-related challenges NGOs faced when attempting to access CSR and other financial resources. Collectively, these barriers limited their ability to establish sustainable partnerships and long-term programs. 2.1 Challenges to sustaining long-term impact Short-term CSR funding cycles were reported as a major constraint. Grants typically lasted only one to three years, discouraging initiatives requiring sustained engagement—such as research, community-based projects, and capacity building. The withdrawal of CSR support often led to premature project discontinuation. Most companies were also reported to have minimal interest in research projects and very few invested in such multi-year obligations ( Q1 , Table 2 ). Additionally, NGOs noted misalignment between their operational timelines and the funding schedules of corporate donors. Although field-based organizations were better positioned to identify community needs, CSR heads typically made funding decisions centrally, resulting in mismatched priorities and discontinuity in implementation ( Q2 , Table 2 ). Table 2 Barriers faced by NGOs in mobilizing CSR funding Subtheme Supporting quotes Challenges to sustaining long-term impact Q1 - ‘ Let's say, research long term impact. I don't see much appetite for that among the CSR community. ‘ - [P2; CEO, NGO] Q2- ‘ There are some CSR. They give you money in the beginning of it never comes in the beginning also. Actually, by the time we send the proposal in March or Feb…whenever they want it, they want the proposal very soon, so that I can do it like one night but the next time by the time the money comes in, it's already May and June. There's a lot that we need to learn, and especially we had a lot of issues with submitting financial documents. There were such so many requirements. They pay you out every quarter.’ - [P11; CSR Lead, NGO] Compliance fatigue among small, field-based NGOs Q3 - ‘ There's a lot of competition for funds, the smaller organizations that really work for that segment of society which needs it the most is not able to compete with the big entities that end up by successfully benefiting from from Csr funding. I don't know how aware people who set up the people in companies who set up their Csr policies. I really have no idea from from the way it looks, it doesn't look like they're really, you know. To me it seems that they just want to do this because the government tells them you have to do it, and then they're trying to do it in such a way that you know.’ - [P17; Founder & CEO, NGO] Q4 - ‘ ‘ You know, the CFOs, because they have a day job running the company so they don't want CSR to be an additional burden for them from a compliance standpoint penalty. So what they do is to make sure that whichever organization I mean really, who can check all the boxes in terms of under the CSR Act.’ - [P2; CEO, NGO] Q5 - ‘ Whether it is regulatory requirement or whether it is what each individual company's CSR policy. There's a lot of paperwork. There's a lot of bureaucracy, a lot of red tape. Not all nonprofits are really equipped to work.’ - [P17; Founder & CEO, NGO] Communication gaps Q6- ‘ A lot of the NGOs’ can't speak that language. They'll not know what metrics are. They'll not know how to get the proper paperwork in order with regard to procurement, and so on. So I feel some of the NGOs’ lose out because they are not able to speak the language of the private sector and for better or worse, NGOs are getting corporatized.’ - [P2; CEO, NGO] 2.2 Compliance fatigue among small, field-based NGOs Smaller NGOs, especially those in tier II/III cities and tribal regions, reported significant difficulty meeting the procedural and documentation requirements for CSR grants. These administrative burdens placed them at a disadvantage compared to larger, urban-based organizations ( Q3 , Table 2 ). From the corporate perspective, partnering with established NGOs simplified compliance and reporting ( Q4 , Table 2 ). This created a dual burden: smaller NGOs lacked the administrative capacity to compete, while corporates avoided them for the same reason, further marginalizing grassroots organizations ( Q5 , Table 2 ). 2.3 Communication gaps Many NGOs struggled to effectively communicate their work and value proposition to potential corporate donors. Limited understanding of proposal writing, documentation standards, and reporting expectations resulted in missed partnership opportunities ( Q6 , Table 2 ). These communication barriers perpetuated inequities, favoring well-networked organizations with stronger advocacy and presentation skills. Theme 3: Facilitators to NGO-CSR collaboration for cancer care Despite these barriers, participants identified several enabling factors that strengthened NGO–CSR collaboration. Hospitals and established NGOs collaborating with upcoming NGOs eased the process of securing CSR for newer NGOs. Other facilitators included CSR support for indirect care costs and personal experiences of philanthropists that motivated engagement in cancer care. 3.1 Partnerships and implementation models Participants described two partnership models that facilitated effective CSR–NGO collaboration in cancer care. The first model involved CSR partnerships with NGOs affiliated with hospitals. Through such associations with government or private hospitals, CSR funds were directed not only toward patient treatment but also toward strengthening hospital infrastructure and procuring equipment ( Q1 , Table 3 ). NGO representatives reported that these collaborations enhanced transparency and accountability, as funds were channeled directly through hospitals, making utilization easier to monitor ( Q2 , Table 3 ). Additionally, signing Memorandums of Understanding (MoUs) with hospitals enhanced NGO credibility and enabled them to negotiate similar agreements with other institutions ( Q3 , Table 3 ). CSR representatives observed that this arrangement allowed companies to support multiple hospitals efficiently, with NGOs managing on-ground coordination of patient needs ( Q4 , Table 3 ). Such partnerships were seen to reduce treatment costs, secure diagnostic and pharmacy discounts, and expand the overall scope of patient support ( Q5 , Table 3 ). However, participants also noted limitations. Multiple NGOs working with the same hospital often operated independently, missing opportunities for coordination and synergy in patient and caregiver support ( Q6 , Table 3 ). Table 3 Facilitators to NGO-CSR Collaboration for Cancer Care Subtheme Supporting quotes Partnerships and implementation models Q1 - “ There is ONGC, there is Tata trust, there is access foundation. There are a lot of funders who are working in cancer. So a lot of them are actually supporting cancer hospitals, infrastructure, wise. They're also supporting equipment, wise, patient support. They are giving a lot of a lot of CSRs are giving patient support. Because when I researched how many CSR are working in cancer, the list is quite long.” - [P12; CSR Head, Corporate Company] Q2 - ‘Decision that we took early on was to make sure that any money that gets transacted doesn't go to the parents. It goes directly to the hospitals that just makes it a lot easier for us to not have to scrutinize where every rupee is spent. We know hospitals are ultimately going to help save lives and get people back healthy again.’ - [P3; Founder & CEO, NGO] Q3 - ‘having that under our belt as the 1st mou that we had helped us negotiate with the other hospitals to say, Hey, they're doing this. Can you do something similar to that?’ - [P3; Founder & CEO, NGO] Q4 - ‘Or we are working with Ngo partners, and then the Ngo partners are working with the hospitals, so we do not have to go to each hospital and ask them for the support that they need to required for the particular patient. But the Ngos does that for us.’ - [P12; CSR Head, Corporate Company] Q5 - ‘They will collaborate with hospital. They will collaborate diagnostic lab they will collaborate with probably pharmacy. They will give at a reduced cost the chemo and the radio and the medicines and all those. And then they will collaborate with the hospital for treatment. They will ask the hospital to reduce their budgets, the pricing that they generally give for the private patient, and then at the end there is an outcome saying that 500 kids will be supported.’ - [P12; CSR head, Corporate Company] Q6 - ‘So I think collaboration and networking is the key solution when we have limited resources, then only we will be able to achieve have that one plus 111 otherwise it will only be two or minus one, something like that, because you will not be able to do everything for the family who is in need.’- [P18; CSR head, Corporate Company] Q7 - ‘What we have tried to do is we partner with a new NGO, and we say, we'll do the project together, and we'll get the funds, and we'll work with you on setting up, etc, etc. But otherwise, for newbie’s, it's tough. The second piece is, for newbie’s, do you, you know, can you afford the internal auditor, the other auditor, thens, the compliance guy, the legal the blah, blah, blah, they can't, right? You just started. So how are you affording all these services.’ - [P8; Founder. NGO] Support for indirect costs of care Q8 - ‘ so we have a management system. It system like a hotel system. So in the mornings every morning. I think we know how many units are empty, how many in any any location, because updated as in the family discharged or whatever. So the my colleague who interacts liaisons with the hospital has. He knows how many units are available in Bombay, and so on. So we tell the hospital that there are 5 units empty. You can. You know we can. Take them in, So some are on a daily rate, like a 100 a day, or I don't know. Some are free, but they are. They'll be like dormitories, you know, not like separate rooms. So the hospital refers some cases there as well.’ - [P2; CEO, NGO] Q9 - ‘ What we can cover is the food cost for the patient. So if you are, you must be aware that most of the cancer patients require a lot of nutrition, nutritional support in terms of protein intake because they require protein at every juncture of their chemo and radiation cycle.’ - [P12; CSR Head, Corporate Company] Q10 - ‘ They are providing educational support… Because when you, if the patient needs to stay there for one year, he's definitely losing his educational cycle completely right ’ - [P12; CSR Head, Corporate Company] Personal experience with disease Q11- ‘ So many a times it comes from experiences, personal experiences which induces people to give for a particular cause. I don't think at times there is a big science around it.’ - [P7; Founder & CEO, NGO] The second model involved collaborations among NGOs themselves. Established organizations reported partnering with emerging NGOs, particularly during their formative stages, to strengthen their operational capacity and visibility. By sharing CSR funds and undertaking joint projects, larger NGOs supported smaller ones in gaining credibility with corporate partners ( Q7 , Table 3 ). Such inter-NGO collaborations illustrated how pooling limited resources could enhance efficiency and amplify collective impact in cancer care delivery. 3.2 Support for indirect costs of care Addressing non-medical needs such as housing, nutrition, and education emerged as an important facilitator of CSR–NGO collaboration. Several companies partnered with NGOs and local service providers to offer subsidized or free lodging for patients’ families through tie-ups with nearby hotels ( Q8 , Table 3 ). Similar collaborations were established to fund nutritional programs that met the specific dietary requirements of cancer patients ( Q9 , Table 3 ). In addition, joint initiatives supported the education of pediatric patients whose schooling was interrupted during treatment ( Q10 , Table 3 ). These efforts demonstrated the potential of CSR–NGO partnerships to holistically address the broader social and economic dimensions of cancer care. 3.3 Personal experience with disease Personal encounters with cancer among philanthropists or their family members emerged as a powerful motivator for CSR giving. Such experiences often led donors to support less visible or stigmatized areas of care, including palliative services and patient support programs ( Q11 , Table 3 ). 4. DISCUSSION This qualitative study explored the dynamics of collaboration between corporate social responsibility (CSR) programs and cancer-focused non-governmental organizations (NGOs) in India. Using in-depth interviews with CSR heads and NGO representatives, the study examined how corporate funding priorities, operational processes, and partnership models shape the landscape of cancer philanthropy. The findings reveal an interplay between corporate visibility-driven motivations and NGO needs grounded in patient-centric service delivery. A prominent theme emerging from the analysis was the selective prioritization of funding areas . Corporations demonstrated a strong inclination to support pediatric cancer programs and curative treatment modalities, driven by higher survival rates and the emotional resonance of helping children. These initiatives were seen as opportunities to generate measurable outcomes and compelling narratives for CSR reporting. In contrast, adult cancer programs, preventive and screening activities, awareness generation, and community-level initiatives received limited attention. Palliative care, integral to comprehensive cancer management, was particularly marginalized, often misconstrued as “end-of-life care” with little scope for visible success. This underscores a broader pattern of “visibility over impact,” where short-term, tangible outcomes are favored over sustained investments in preventive and supportive care. Such practices, often termed bluewashing ( 18 ) , reflect a tendency among corporations to align CSR activities with brand enhancement and public image ( 19 ) rather than long-term health system strengthening. The study also identified multiple operational challenges that impede equitable access to CSR funding among NGOs. Smaller and community-based organizations frequently lacked the administrative capacity, proposal-writing skills, and documentation processes required to navigate the corporate funding environment. The bureaucratic and compliance-heavy nature of CSR reporting mechanisms created barriers that disproportionately affected grassroots NGOs. These challenges mirror patterns noted in other low-resource settings like Malawi and Ghana, where smaller NGOs struggled due to low resources for administrative and reporting demands by donors ( 20 , 21 ) . Additionally, a geographic concentration of CSR spending was observed, consistent with national data showing that a majority of CSR allocations are directed toward industrialized states such as Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Delhi, and Gujarat. This concentration reflects a misinterpretation of the CSR Act (2013), which recommends, but does not mandate, local area preference for CSR implementation. Consequently, NGOs operating in remote and underserved regions, where the burden of cancer is often higher and access to care lower, remain underfunded ( 22 ) . This urban bias in CSR allocation is similar to global funding trends. A study on the spatial analysis of aid distribution in 38 sub-Saharan African countries showed that philanthropic spending is concentrated in industrialized centres due to factors like population density, accessibility, and political prominence ( 23 ) . Despite these challenges, there exist opportunities for enhancing CSR impact. CSR funds have demonstrably reduced the financial burden on cancer patients, particularly through direct financial aid and support for treatment costs. Innovative partnership models and various initiatives by SBI, HDFC, Pfizer, Tata Trusts, etc, with like-minded organisations, demonstrate the potential for holistic funding for cancer care ( 24 ) . Support for lodging, nutritional needs, and educational continuity for patients and caregivers were identified as areas that can further expand the impact of CSR investment. Furthermore, larger NGOs partnered with nascent organisations to aid them in capacity building and funding. This offers a promising pathway to address geographical and capacity disparities. Policy recommendations The findings of this study underscore the need for structural reforms to optimize the role of Corporate Social Responsibility (CSR) in strengthening cancer care delivery in India. Given the socioeconomic burden of cancer, policies should mandate that a defined fraction of CSR expenditure be allocated for cancer care. Policy frameworks should broaden the scope of eligible CSR activities to include preventive, palliative, and community-based interventions, along with essential operational and capacity-building costs such as staff salaries, training, and infrastructure maintenance. Recognizing these components as integral to effective cancer care would enable NGOs to sustain long-term, quality-driven programs rather than limiting CSR to short-term, highly visible interventions. To address the current concentration of CSR funding in urban and corporate-linked areas, policies should encourage geographic equity by incentivizing investments in underserved and rural regions. Mechanisms such as tax benefits, recognition schemes, or matching grants could be introduced to promote equitable distribution of resources. Further, CSR regulations should support multi-year commitments linked to measurable outcomes rather than annual expenditure cycles, enabling continuity of programs in areas such as research, patient support, and rehabilitation. To support newly established NGOs, CSR certification requirements should be revised and complemented with mechanisms that help credible new organisations access CSR funding. Simplifying compliance procedures and building the administrative capacity of smaller NGOs are also critical. National or state-level facilitation platforms could provide standardized templates, training modules, and certification support to help grassroots organizations meet CSR requirements. Streamlined reporting systems would reduce administrative burdens and promote efficiency. Additionally, the creation of centralized digital or regional platforms to connect corporates with credible NGOs in specific health domains could enhance transparency, reduce duplication, and ensure evidence-based resource allocation. Finally, CSR contributions should be integrated within the framework of national cancer control strategies, such as the National Programme for Prevention and Control of Non-Communicable Diseases (NPNCD). Aligning corporate initiatives with public health priorities would ensure complementarity and long-term system strengthening. Beyond statutory compliance, corporates should be encouraged to adopt a compassionate and socially responsive approach that values equity, dignity, and sustainability. Promoting best practices and recognizing successful CSR–NGO collaborations, particularly those addressing neglected or marginalized cancer populations, can help cultivate an ecosystem of responsible and inclusive health philanthropy. Strengths and limitations This study is among the few qualitative inquiries exploring the perspectives of both NGO representatives and CSR heads in the context of cancer care in India, providing a nuanced understanding of the dynamics shaping philanthropic and corporate engagement in health. The inclusion of participants from diverse organizational backgrounds, ranging from grassroots NGOs to corporate CSR divisions, enabled triangulation of perspectives and enriched the depth of analysis. However, the study’s findings are based on a relatively small, purposively selected sample and may not be generalizable to all CSR or NGO contexts beyond cancer care or beyond India. Since most interviews were conducted online, non-verbal cues and contextual nuances may have been partially missed. Additionally, participants’ self-reported accounts may be influenced by social desirability or institutional affiliation, potentially introducing response bias. Finally, while triangulation among multiple coders enhanced consistency, the analysis may still reflect interpretive subjectivity inherent in qualitative research. CONCLUSION This study highlights the impact of CSR spending by corporate companies on cancer-focused NGOs in India, showing what hurdles non-profits navigate through when seeking CSR funding. While India’s mandatory CSR legislation has increased the investment for social development, its full potential in cancer care remains untapped due to misaligned priorities, geographic disparities, and administrative burdens. CSR must engage in equitable investments across the entire cancer care continuum that empower local NGOs and address pressing but often overlooked needs of patients. Future research should explore quantitative analysis of CSR spending trends on cancer care across geographical locations and years. Longitudinal studies should explore CSR-NGO partnerships and their long-term impact on cancer care. Declarations Conflict of interest: Nil Funding: Persistent Foundation Study to be presented at ESMO Asia Congress 2025 References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229–263 Donkor A, Atuwo-Ampoh VD, Yakanu F, Torgbenu E, Ameyaw EK, Kitson-Mills D et al (2022) Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis. Support Care Cancer 30(9):7159–7190 Nair ADT, Abhijath P, Jha V, Aarthy V (2020) Economics of cancer care: A community-based cross-sectional study in Kerala, India. South Asian J Cancer 09(01):07–12 Desai A, Gyawali B (2020) Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine 20:100269 Akhtar MA, Chowdhury IR, Taneja B (2025) Healthcare utilisation and economic burden of cancer on Indian households. Sci Rep 15(1):16780 Thomas AR, Dash U, Sahu SK (2023) Illnesses and hardship financing in India: an evaluation of inpatient and outpatient cases, 2014-18. BMC Public Health 23:204 Prinja S, Dixit J, Gupta N, Dhankhar A, Kataki AC, Roy PS et al (2023 June) Financial toxicity of cancer treatment in India: towards closing the cancer care gap. Front Public Health 19:11:1065737 Kamath S, Maliyekkal J, Elstin Anbu Raj S, Varshini RJ, Brand H, Sirur A et al (2025 June) Understanding out-of-pocket expenditure in India: a systematic review. Front Public Health 9:13:1594542 Barrios C, de Lima Lopes G, Yusof MM, Rubagumya F, Rutkowski P, Sengar M (2023) Barriers in access to oncology drugs — a global crisis. Nat Rev Clin Oncol 20(1):7–15 Doshmangir L, Sanadghol A, Kakemam E, Majdzadeh R (2025) The involvement of non-governmental organisations in achieving health system goals based on the WHO six building blocks: A scoping review on global evidence. PLoS ONE 20(1):e0315592 Pramesh CS, Sengar M, Patankar S, Chinnaswamy G, Gupta S, Vijayakumar M et al (2023 Sept) A National Cancer Grid pooled procurement initiative, India. Bull World Health Organ 101(1):587–594 Jaitley S, Mehta D, Lalwani H, Malhotra P, Jain S, Kapoor G (2025) A Comprehensive 360˚ Philanthropic Support Model: Holistic and Sustainable Approaches to Childhood Cancers (0–19 years) in a Tertiary Cancer Hospital in India. Asian Pac J Cancer Nurs. ;20250520–20250520 Companies A (2013) [Internet] [cited 2025 Nov 2]. Available from: https://www.mca.gov.in/content/mca/global/en/acts-rules/companies-act/companies-act-2013.html Help & FAQs [Internet]. [cited 2025 Nov 2]. Available from: https://www.csr.gov.in/content/csr/global/master/home/helpandfaqs.html Pareet DYJ and DP. Cancer control: Can CSR change the future of cancer care in India? The Times of India [Internet]. [cited 2025 Nov 2]; Available from: https://timesofindia.indiatimes.com/blogs/voices/cancer-control-can-csr-change-the-future-of-cancer-care-in-india/ Journal TC Top CSR projects catering to cancer patients in India [Internet]. The CSR Journal. 2025 [cited 2025 Nov 2]. Available from: https://thecsrjournal.in/world-cancer-day-top-csr-projects-cancer-patients-india-2/ CSR Pfizer’s Cancer Care Programs Benefit Over 6,00,000 People In India - India CSR [Internet]. 2023 [cited 2025 Nov 2]. Available from: https://indiacsr.in/pfizers-cancer-care-programs-benefit-over-600000-people-in-india/ McClimon TJ Forbes. [cited 2025 Dec 1]. Bluewashing Joins Greenwashing As The New Corporate Whitewashing. Available from: https://www.forbes.com/sites/timothyjmcclimon/2022/10/03/bluewashing-joins-greenwashing-as-the-new-corporate-whitewashing/ Mu H, Lee Y (2023) Greenwashing in Corporate Social Responsibility: A Dual-Faceted Analysis of Its Impact on Employee Trust and Identification. Sustainability 15(22):15693 Arhin AA, Kumi E, Adam MAS (2018) Facing the Bullet? Non-Governmental Organisations’ (NGOs’) Responses to the Changing Aid Landscape in Ghana. Volunt Int J Volunt Nonprofit Organ 29(2):348–360 Kermani F, Reandi STA Exploring the Funding Challenges Faced by Small NGOs: Perspectives from an Organization with Practical Experience of Working in Rural Malawi. Res Rep Trop Med 2023 Sept 1;14:99–110 CSR spending heavily concentrated in six states report flags neglect of underdeveloped regions [Internet]. [cited 2025 Dec 1]. Available from: https://www.newindianexpress.com/nation/2025/Aug/08/csr-spending-heavily-concentrated-in-six-states-report-flags-neglect-of-underdeveloped-regions Shon H, Lee H, Kim B (2024) Spatial pattern of aid allocation in the early 21st century: Evidence from 38 sub-Saharan African countries. Pap Reg Sci. June 1;103(3):100026 World Cancer Day (2023) : Top CSR projects catering to cancer patients in India - The CSR Journal [Internet]. [cited 2025 Dec 1]. Available from: https://thecsrjournal.in/world-cancer-day-top-csr-projects-cancer-patients-india/ Additional Declarations The authors declare no competing interests. Supplementary Files CSRsupplementfile.docx Interview Guide Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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03:01:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":9037,"visible":true,"origin":"","legend":"\u003cp\u003eInterview Guide\u003c/p\u003e","description":"","filename":"CSRsupplementfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-8256379/v1/1d312b911e002b5f05ffdd51.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe Role of Businesses in Supporting Non-Governmental Organisation for Cancer Care in India: Priorities, Barriers, and Facilitators\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eCancer is a leading cause of morbidity and mortality globally\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. In low- and middle-income countries (LMICs), cancer treatment imposes a high financial burden on patients and their families\u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. This burden manifests in several ways, including direct medical costs for diagnosis, treatment, hospitalization, etc; non-medical costs for transportation, accommodation, food, and indirect costs due to loss of income and productivity\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e. To meet these expenses, patients with cancer and their families frequently incur high out-of-pocket expenditures\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e. In 2017, more than 75% of households in India affected by cancer experienced catastrophic expenditures to meet the costs of treatment\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIndia introduced various public and private insurance to ease the financial burden on patients with cancer. However, the effectiveness of such measures remains limited due to scarce coverage, inconsistent implementation, and exclusion of outpatient expenditures\u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. Additionally, public health expenditure in India has remained below 2% of the Gross Domestic Product (GDP)\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. Due to this, patients with cancer face a dual burden: public hospitals lack advanced facilities due to low funding, while private hospitals, though better equipped, are unaffordable for most patients\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEfforts by various non-governmental organisations (NGOs) and philanthropic initiatives play an important role in alleviating such health disparities by bridging financial gaps\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. For example, in India, the National Cancer Grid piloted a pooled procurement process for cancer and other supportive care medicines, thus reducing the cost of such drugs by 82%\u003csup\u003e(11)\u003c/sup\u003e. Another initiative at the Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), New Delhi, provides a \u0026lsquo;360 degree\u0026rsquo; philanthropic support model for patients belonging to the pediatric age group\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. The philanthropic model is supported by various sources, most notably through corporate social responsibility (CSR) contributions from public sector undertakings (PSUs) and corporations.\u003c/p\u003e\u003cp\u003eCorporate social responsibility (CSR) in India is governed by Section 135 of the Companies Act, 2013. It mandates eligible companies to contribute to social welfare projects by investing 2% of their average net profit, based on the previous three consecutive financial years\u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/sup\u003e. To qualify for CSR under the Companies Act 2013, a company must fulfill any one of the following criteria during the immediately preceding financial year: net worth of rupees five hundred crore or more, a turnover of rupees one thousand crore or more, or a net profit of rupees five crore or more\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e. CSR is implemented via a company-established trust/foundation, registered NGOs, or collaborations with other companies. Healthcare has been a major sector of investment, receiving nearly 26% of all the CSR funds in the financial year of 2020\u0026ndash;2021\u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e. Numerous CSR initiatives target cancer care by funding new oncology hospitals, mobile screening units, patient lodgings, and awareness groups\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e. While CSR contributions to non-profit organisations have been imperative to support such cancer-specific programs\u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e, there is a notable lack of research on how CSR and non-profits interact, how CSR funds are allocated to cancer-focused NGOs, how partnerships are formed and maintained, or what mutual expectations and constraints shape these collaborations.\u003c/p\u003e\u003cp\u003eThe primary objective of this study was to identify the factors that influence CSR spending on cancer projects. The study also aimed to report the hurdles that non-profit organisations face when accessing CSR funding and propose facilitators to increase CSR contribution to cancer care. By unraveling these aspects, the research aims to inform actionable insights of alleviating financial burdens by facilitating support for people undergoing cancer treatment in India and comparable low- and middle-income countries (LMICs).\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study designs and participants\u003c/h2\u003e\u003cp\u003eWe conducted a qualitative study using purposive and snowball sampling. Twenty-nine informants (22 NGO and 7 CSR representatives) across diverse institutions (established NGOs, specialised cancer care foundations, and corporate companies) and geographical locations, including urban and semi-urban organisations across 7 Indian states, were approached. This approach aimed to capture varied perspectives on the role of CSR funding along with the challenges it poses to cancer-related non-profit organisations.\u003c/p\u003e\u003cp\u003e The study was approved by the Biomedical and Health Research Ethics Committee, Jehangir Clinical Development Centre Pvt. Ltd., with a waiver of ethical clearance granted as no patient or clinical data were involved (EC Registration No.: EC/NEW/INST/2023/MH/0236).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data collection\u003c/h2\u003e\u003cp\u003eIn-depth interviews were conducted in English and Hindi by two investigators (PoS and VK), who had no prior relationship with the participants, to minimize potential bias. Each interview began with an orientation outlining the study\u0026rsquo;s purpose, objectives, and ethical safeguards.\u003c/p\u003e\u003cp\u003eA semi-structured interview guide (Supplementary file) was initially drafted by VK based on a review of existing literature on health philanthropy, civil society engagement, and corporate social responsibility (CSR) in healthcare. This guide was subsequently refined by PoS and reviewed by a co-author with expertise in qualitative research (PaS) to enhance its contextual relevance and content validity. The final guide included open-ended questions aimed at eliciting rich narratives regarding the organizations\u0026rsquo; operational structures, funding priorities, decision-making processes, collaborative models, and perceived contributions to cancer care.\u003c/p\u003e\u003cp\u003eParticipants were purposively selected to include representatives of non-profit organizations that sought or received CSR funding, as well as CSR heads or senior representatives of corporate entities engaged in healthcare philanthropy. All interviews were conducted online between January and March 2025. Each session lasted approximately 45\u0026ndash;60 minutes and was audio-recorded with the participant\u0026rsquo;s informed consent. Data collection continued until thematic saturation was achieved, defined as the point at which no new insights or themes emerged from successive interviews, determined jointly by the two investigators.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data analysis\u003c/h2\u003e\u003cp\u003eOne interview conducted in Hindi was manually translated and transcribed into English, while the remaining 17 interviews were transcribed in English using either the Zoom transcription function or Turboscribe software. All transcripts were manually reviewed and verified for accuracy by PoS. To maintain confidentiality, all identifying details were removed before analysis.\u003c/p\u003e\u003cp\u003eData were analyzed using Dedoose (version 10.0.25). A hybrid approach combining deductive and inductive thematic analysis was employed. Preliminary codes were developed deductively from theoretical frameworks on civil society participation, philanthropic capital, and health systems governance. Additional codes and subthemes emerged inductively through iterative reading of the transcripts.\u003c/p\u003e\u003cp\u003eThe analytic process proceeded in multiple stages. In the first phase, open coding was conducted to identify key concepts and recurring ideas relating to the motivations, constraints, and experiences of non-profit and corporate stakeholders. In the second phase, axial coding was performed to organize these codes into higher-order thematic categories such as strategic alignment, administrative challenges, accountability mechanisms, and partnership dynamics. The analysis remained iterative, with regular revisiting of transcripts to ensure that emergent themes were grounded in the data.\u003c/p\u003e\u003cp\u003e To enhance analytic rigor, primary coding was undertaken by PoS and independently reviewed by VK for consistency and thematic completeness. A third researcher (PaS) subsequently reviewed the final coding framework to ensure conceptual accuracy and contextual coherence. Discrepancies were resolved through discussion and consensus among the research team.\u003c/p\u003e\u003cp\u003eThe entire analytic process adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure methodological transparency, reflexivity, and credibility of the findings.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Participant characteristics\u003c/h2\u003e\u003cp\u003eFor this study, we interviewed participants from NGOs as well as corporate companies. The participants from the NGOs were either the founder members (n\u0026thinsp;=\u0026thinsp;9) or the CEOs (n\u0026thinsp;=\u0026thinsp;1), and in a few cases, the CSR leads (n\u0026thinsp;=\u0026thinsp;5) employed by the NGOs. As for the corporate companies, we interviewed CSR heads (n\u0026thinsp;=\u0026thinsp;3) engaged in funding cancer care projects. Data saturation was achieved after 18 interviews with participants of diverse backgrounds. The participants represented organisations involved in different areas of cancer care, like palliative care, pediatric cancers, cervical cancer, cancer genomics, cancer screening, awareness, and advocacy, and hailed from seven different states in India.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Themes\u003c/h2\u003e\u003cp\u003e\u003cb\u003eTheme 1: Factors affecting CSR spending in cancer care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis theme captures the divergent priorities of NGOs and corporate CSR representatives across three dimensions: type of services funded, geographic distribution of funding, and nature of support provided. While NGOs sought resources aligned with community needs, CSR representatives tended to prioritize projects that were measurable, visible, or demonstrated short-term impact. This misalignment often led to a gap between NGO needs and available CSR funding.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Difference in focus areas\u003c/h2\u003e\u003cp\u003eNGO representatives highlighted an incongruity between the services they provided and those that attracted CSR support. Preventive, screening, and awareness activities in cancer care received minimal attention (\u003cb\u003eQ1\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and NGOs offering palliative care services struggled to secure funding, as companies often perceived such care as end-of-life support (\u003cb\u003eQ2\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors affecting CSR spending in cancer care\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupporting Quotes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDifference in focus areas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eQ1 - \u0026lsquo;We do not feel that kind of work that we are doing in prevention primarily, and survivorship is of a lot of interest to more CSR. They are interested in either getting treatment for the individuals or getting health checkups and that sort of a thing. Rather than you know, talking about prevention, which is a lifestyle thing as well as vaccination, which I don't think we have the traction as yet.\u0026rsquo; -\u003c/em\u003e [P9; CSR lead, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ2- \u0026lsquo;.....for us, it's just palliative care\u0026hellip;that is way below cancer care\u0026hellip; we are way down than cancer care. \u0026lsquo; -\u003c/em\u003e [P11; CSR lead, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ3-\u003c/em\u003e \u0026lsquo; \u003cem\u003eSo even if you talk with a lot of when I talk with a lot of hospitals, and I ask them, what is your requirement? They say, give me amount for heart, and then you give me amount for cancer. They will not ask amount for any other diseases, because per person expenditure for other diseases is quite low. It's maximum into cancer.\u0026rsquo;\u003c/em\u003e - [P12; CSR head, Corporate company]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ4 - \u0026lsquo;Also, you will get more (funds) for cancer treatment. You will get less (funds) for cancer screening and awareness, right\u0026hellip;. for cancer prevention.\u003c/em\u003e - [P5; CSR lead, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimited support for operational or capacity-building costs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eQ5- \u0026lsquo;But when it comes to CSR programs in these smaller tier 2 cities or other places they would prefer more of\u0026hellip;They would be happy to give 100 wheelchairs and not support a salary of a physiotherapist. So that kind of a thing is still \u0026hellip;that mindset is still there, and they would prefer to still do those one off events where they're gifting people something, or you know, or taking pictures. \u0026rsquo;\u003c/em\u003e - [P11; CSR lead, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBias toward urban or corporate-linked geographies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eQ6-\u003c/em\u003e \u0026lsquo;\u003cem\u003eKerala has very limited CSR. Because, 1st of all, the location, not many. Most of the parent companies are in Hyderabad, Bangalore, Pune, Bombay, Delhi. So, and they would prefer to walk around their vicinities. And that's also that's something that CSR does. They prefer their own geographical locations and others.\u0026rsquo;\u003c/em\u003e - [P11; CSR lead, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ7- \u0026lsquo;....there's a portion in the CSR Act which is interpreted wrongly by CSRs that they can support only within 45 kilometers of their head offices or manufacturing units. The line says that it is preferred that they support, but it does not say that it it has to be supported there. So, and you know, sometimes CSR managers do not. They are fixated on what the narrative is rather than what the possibilities are. So we lose lose out on many CSR because of the 45 kilometer range.\u0026rsquo; -\u003c/em\u003e[P1; CEO, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ8-\u003c/em\u003e \u0026lsquo;\u003cem\u003eUnfortunately, maximum goes into Maharashtra, Karnataka Delhi. These States don't really have a need for CSR money. I mean, it's just that companies operate. They want to do something around their plants or their units. They want to be seen to be good corporate citizens, but that's not where the need is? The need actually is in these, in the northeast or in the aspirational districts.\u0026rsquo;\u003c/em\u003e - [P7; Founder, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisease outcome dependent funding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eQ9- \u0026lsquo;I can tell you that it's much easier to draft CSR funding for pediatric cancer. One of the reasons for it\u0026hellip; Couple of reasons, really, I mean, from what you anecdotally know, one is that recovery rate survival rate is much better in adults in children. Survival rate is better so. And that's again, that's something that we share with donors as well that you know, our rate is close to 70%. So that's appealing to many donors understandably.\u0026rsquo; -\u003c/em\u003e [P2; CEO, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ10- \u0026lsquo;She gets more consideration the minute you say that they are children, and they can be treated, and we can give them a better life it is just a more emotional connect for us.\u0026rsquo; -\u003c/em\u003e [P5; CSR lead, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ11\u003c/em\u003e - \u0026lsquo;\u003cem\u003eit's a struggle to get funding for adult cancers. So it may be a larger cancer. But everybody thinks that, you know putting money into cancer is drowning it\u0026hellip; There is nothing that comes out of it. We don't manage to save so many people so definitely in that way. It is not equitable.\u0026rsquo; -\u003c/em\u003e [P5; CSR lead, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ12- \u0026lsquo;there is a wrong notion, especially in India that adult cancers are self-inflicted, due to smoking or tobacco, and so on. I mean, there is a notion not like anybody asks us. Nobody ever I mean\u0026hellip; nobody really blames children for their condition.\u0026rsquo; -\u003c/em\u003e[P2; CEO, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCSR representatives, in contrast, were influenced by narratives of visibility, impact, and scalability. Hospitals often presented diagnostic and treatment-based interventions as high-impact opportunities, attracting greater CSR investment (\u003cb\u003eQ3\u0026ndash;Q4\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Consequently, initiatives such as lifestyle modification or vaccination, though essential, were overlooked due to their less tangible outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Limited support for operational or capacity-building costs\u003c/h2\u003e\u003cp\u003eNGOs reported persistent challenges in obtaining support for essential operational expenses, such as staff salaries and training. While these costs were crucial for service continuity, CSR funds rarely covered them. Corporates preferred donating visible assets, like medical equipment or infrastructure, where impact could be easily showcased (\u003cb\u003eQ5\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This preference for tangibility left NGOs struggling to maintain personnel and facilities.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Bias toward urban or corporate-linked geographies\u003c/h2\u003e\u003cp\u003eCSR investments were reported to be heavily concentrated in metropolitan areas. Participants attributed this to logistical convenience and the misconception that CSR funds must be utilized within a fixed radius, often cited as 45 kilometers, of corporate operations (\u003cb\u003eQ6\u0026ndash;Q7\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This misunderstanding, combined with urban-centric preferences, left NGOs in rural and remote areas underfunded, despite their direct engagement with underserved communities (\u003cb\u003eQ8\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e1.4 Disease outcome dependent funding\u003c/h2\u003e\u003cp\u003eA strong preference for funding pediatric cancer initiatives emerged, driven by higher survival rates and the emotional appeal associated with supporting children (\u003cb\u003eQ9\u0026ndash;Q10\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In contrast, adult cancer programs faced funding barriers, reflecting both lower survival prospects and a societal tendency to ascribe greater value to saving children\u0026rsquo;s lives (\u003cb\u003eQ11\u0026ndash;Q12\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This bias contributed to the inequitable allocation of CSR resources across different cancer types.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Barriers faced by NGOs in mobilizing CSR funding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis theme outlines the systemic, administrative, and communication-related challenges NGOs faced when attempting to access CSR and other financial resources. Collectively, these barriers limited their ability to establish sustainable partnerships and long-term programs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Challenges to sustaining long-term impact\u003c/h2\u003e\u003cp\u003eShort-term CSR funding cycles were reported as a major constraint. Grants typically lasted only one to three years, discouraging initiatives requiring sustained engagement\u0026mdash;such as research, community-based projects, and capacity building. The withdrawal of CSR support often led to premature project discontinuation. Most companies were also reported to have minimal interest in research projects and very few invested in such multi-year obligations (\u003cb\u003eQ1\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, NGOs noted misalignment between their operational timelines and the funding schedules of corporate donors. Although field-based organizations were better positioned to identify community needs, CSR heads typically made funding decisions centrally, resulting in mismatched priorities and discontinuity in implementation (\u003cb\u003eQ2\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBarriers faced by NGOs in mobilizing CSR funding\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupporting quotes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChallenges to sustaining long-term impact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ1 - \u0026lsquo;\u003cem\u003eLet's say, research long term impact. I don't see much appetite for that among the CSR community. \u0026lsquo; -\u003c/em\u003e [P2; CEO, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ2-\u003c/em\u003e \u0026lsquo;\u003cem\u003eThere are some CSR. They give you money in the beginning of it never comes in the beginning also. Actually, by the time we send the proposal in March or Feb\u0026hellip;whenever they want it, they want the proposal very soon, so that I can do it like one night but the next time by the time the money comes in, it's already May and June. There's a lot that we need to learn, and especially we had a lot of issues with submitting financial documents. There were such so many requirements. They pay you out every quarter.\u0026rsquo; -\u003c/em\u003e [P11; CSR Lead, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompliance fatigue among small, field-based NGOs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ3 - \u0026lsquo;\u003cem\u003eThere's a lot of competition for funds, the smaller organizations that really work for that segment of society which needs it the most is not able to compete with the big entities that end up by successfully benefiting from from Csr funding. I don't know how aware people who set up the people in companies who set up their Csr policies. I really have no idea from from the way it looks, it doesn't look like they're really, you know. To me it seems that they just want to do this because the government tells them you have to do it, and then they're trying to do it in such a way that you know.\u0026rsquo;\u003c/em\u003e - [P17; Founder \u0026amp; CEO, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ4 - \u0026lsquo;\u003c/em\u003e\u0026lsquo;\u003cem\u003eYou know, the CFOs, because they have a day job running the company so they don't want CSR to be an additional burden for them from a compliance standpoint penalty. So what they do is to make sure that whichever organization I mean really, who can check all the boxes in terms of under the CSR Act.\u0026rsquo; -\u003c/em\u003e [P2; CEO, NGO]\u003c/p\u003e\u003cp\u003eQ5 - \u0026lsquo;\u003cem\u003eWhether it is regulatory requirement or whether it is what each individual company's CSR policy. There's a lot of paperwork. There's a lot of bureaucracy, a lot of red tape. Not all nonprofits are really equipped to work.\u0026rsquo; -\u003c/em\u003e [P17; Founder \u0026amp; CEO, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunication gaps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ6- \u0026lsquo;\u003cem\u003eA lot of the NGOs\u0026rsquo; can't speak that language. They'll not know what metrics are. They'll not know how to get the proper paperwork in order with regard to procurement, and so on. So I feel some of the NGOs\u0026rsquo; lose out because they are not able to speak the language of the private sector and for better or worse, NGOs are getting corporatized.\u0026rsquo; -\u003c/em\u003e [P2; CEO, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Compliance fatigue among small, field-based NGOs\u003c/h2\u003e\u003cp\u003eSmaller NGOs, especially those in tier II/III cities and tribal regions, reported significant difficulty meeting the procedural and documentation requirements for CSR grants. These administrative burdens placed them at a disadvantage compared to larger, urban-based organizations (\u003cb\u003eQ3\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). From the corporate perspective, partnering with established NGOs simplified compliance and reporting (\u003cb\u003eQ4\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This created a dual burden: smaller NGOs lacked the administrative capacity to compete, while corporates avoided them for the same reason, further marginalizing grassroots organizations (\u003cb\u003eQ5\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Communication gaps\u003c/h2\u003e\u003cp\u003eMany NGOs struggled to effectively communicate their work and value proposition to potential corporate donors. Limited understanding of proposal writing, documentation standards, and reporting expectations resulted in missed partnership opportunities (\u003cb\u003eQ6\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These communication barriers perpetuated inequities, favoring well-networked organizations with stronger advocacy and presentation skills.\u003c/p\u003e\u003cp\u003e\u003cb\u003e Theme 3: Facilitators to NGO-CSR collaboration for cancer care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite these barriers, participants identified several enabling factors that strengthened NGO\u0026ndash;CSR collaboration. Hospitals and established NGOs collaborating with upcoming NGOs eased the process of securing CSR for newer NGOs. Other facilitators included CSR support for indirect care costs and personal experiences of philanthropists that motivated engagement in cancer care.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.1 Partnerships and implementation models\u003c/b\u003eParticipants described two partnership models that facilitated effective CSR\u0026ndash;NGO collaboration in cancer care.\u003c/p\u003e\u003cp\u003eThe first model involved CSR partnerships with NGOs affiliated with hospitals. Through such associations with government or private hospitals, CSR funds were directed not only toward patient treatment but also toward strengthening hospital infrastructure and procuring equipment (\u003cb\u003eQ1\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). NGO representatives reported that these collaborations enhanced transparency and accountability, as funds were channeled directly through hospitals, making utilization easier to monitor (\u003cb\u003eQ2\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Additionally, signing Memorandums of Understanding (MoUs) with hospitals enhanced NGO credibility and enabled them to negotiate similar agreements with other institutions (\u003cb\u003eQ3\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). CSR representatives observed that this arrangement allowed companies to support multiple hospitals efficiently, with NGOs managing on-ground coordination of patient needs (\u003cb\u003eQ4\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Such partnerships were seen to reduce treatment costs, secure diagnostic and pharmacy discounts, and expand the overall scope of patient support (\u003cb\u003eQ5\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, participants also noted limitations. Multiple NGOs working with the same hospital often operated independently, missing opportunities for coordination and synergy in patient and caregiver support (\u003cb\u003eQ6\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFacilitators to NGO-CSR Collaboration for Cancer Care\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupporting quotes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartnerships and implementation models\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ1\u003cem\u003e-\u003c/em\u003e \u0026ldquo;\u003cem\u003eThere is ONGC, there is Tata trust, there is access foundation. There are a lot of funders who are working in cancer. So a lot of them are actually supporting cancer hospitals, infrastructure, wise. They're also supporting equipment, wise, patient support. They are giving a lot of a lot of CSRs are giving patient support. Because when I researched how many CSR are working in cancer, the list is quite long.\u0026rdquo;\u003c/em\u003e - [P12; CSR Head, Corporate Company]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ2 - \u0026lsquo;Decision that we took early on was to make sure that any money that gets transacted doesn't go to the parents. It goes directly to the hospitals that just makes it a lot easier for us to not have to scrutinize where every rupee is spent. We know hospitals are ultimately going to help save lives and get people back healthy again.\u0026rsquo; -\u003c/em\u003e [P3; Founder \u0026amp; CEO, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ3 - \u0026lsquo;having that under our belt as the 1st mou that we had helped us negotiate with the other hospitals to say, Hey, they're doing this. Can you do something similar to that?\u0026rsquo; -\u003c/em\u003e [P3; Founder \u0026amp; CEO, NGO]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ4 - \u0026lsquo;Or we are working with Ngo partners, and then the Ngo partners are working with the hospitals, so we do not have to go to each hospital and ask them for the support that they need to required for the particular patient. But the Ngos does that for us.\u0026rsquo; -\u003c/em\u003e [P12; CSR Head, Corporate Company]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ5 - \u0026lsquo;They will collaborate with hospital. They will collaborate diagnostic lab they will collaborate with probably pharmacy. They will give at a reduced cost the chemo and the radio and the medicines and all those. And then they will collaborate with the hospital for treatment. They will ask the hospital to reduce their budgets, the pricing that they generally give for the private patient, and then at the end there is an outcome saying that 500 kids will be supported.\u0026rsquo; -\u003c/em\u003e[P12; CSR head, Corporate Company]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ6 - \u0026lsquo;So I think collaboration and networking is the key solution when we have limited resources, then only we will be able to achieve have that one plus 111 otherwise it will only be two or minus one, something like that, because you will not be able to do everything for the family who is in need.\u0026rsquo;-\u003c/em\u003e [P18; CSR head, Corporate Company]\u003c/p\u003e\u003cp\u003e\u003cem\u003eQ7 - \u0026lsquo;What we have tried to do is we partner with a new NGO, and we say, we'll do the project together, and we'll get the funds, and we'll work with you on setting up, etc, etc. But otherwise, for newbie\u0026rsquo;s, it's tough. The second piece is, for newbie\u0026rsquo;s, do you, you know, can you afford the internal auditor, the other auditor, thens, the compliance guy, the legal the blah, blah, blah, they can't, right? You just started. So how are you affording all these services.\u0026rsquo; -\u003c/em\u003e[P8; Founder. NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupport for indirect costs of care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ8 - \u0026lsquo;\u003cem\u003eso we have a management system. It system like a hotel system. So in the mornings every morning. I think we know how many units are empty, how many in any any location, because updated as in the family discharged or whatever. So the my colleague who interacts liaisons with the hospital has. He knows how many units are available in Bombay, and so on. So we tell the hospital that there are 5 units empty. You can. You know we can. Take them in, So some are on a daily rate, like a 100 a day, or I don't know. Some are free, but they are. They'll be like dormitories, you know, not like separate rooms. So the hospital refers some cases there as well.\u0026rsquo; -\u003c/em\u003e [P2; CEO, NGO]\u003c/p\u003e\u003cp\u003eQ9 - \u0026lsquo;\u003cem\u003eWhat we can cover is the food cost for the patient. So if you are, you must be aware that most of the cancer patients require a lot of nutrition, nutritional support in terms of protein intake because they require protein at every juncture of their chemo and radiation cycle.\u0026rsquo; -\u003c/em\u003e [P12; CSR Head, Corporate Company]\u003c/p\u003e\u003cp\u003eQ10 - \u0026lsquo;\u003cem\u003eThey are providing educational support\u0026hellip; Because when you, if the patient needs to stay there for one year, he's definitely losing his educational cycle completely right \u0026rsquo; -\u003c/em\u003e [P12; CSR Head, Corporate Company]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal experience with disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ11- \u0026lsquo;\u003cem\u003eSo many a times it comes from experiences, personal experiences which induces people to give for a particular cause. I don't think at times there is a big science around it.\u0026rsquo; -\u003c/em\u003e [P7; Founder \u0026amp; CEO, NGO]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe second model involved collaborations among NGOs themselves. Established organizations reported partnering with emerging NGOs, particularly during their formative stages, to strengthen their operational capacity and visibility. By sharing CSR funds and undertaking joint projects, larger NGOs supported smaller ones in gaining credibility with corporate partners (\u003cb\u003eQ7\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Such inter-NGO collaborations illustrated how pooling limited resources could enhance efficiency and amplify collective impact in cancer care delivery.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Support for indirect costs of care\u003c/h2\u003e\u003cp\u003eAddressing non-medical needs such as housing, nutrition, and education emerged as an important facilitator of CSR\u0026ndash;NGO collaboration. Several companies partnered with NGOs and local service providers to offer subsidized or free lodging for patients\u0026rsquo; families through tie-ups with nearby hotels (\u003cb\u003eQ8\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Similar collaborations were established to fund nutritional programs that met the specific dietary requirements of cancer patients (\u003cb\u003eQ9\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, joint initiatives supported the education of pediatric patients whose schooling was interrupted during treatment (\u003cb\u003eQ10\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These efforts demonstrated the potential of CSR\u0026ndash;NGO partnerships to holistically address the broader social and economic dimensions of cancer care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Personal experience with disease\u003c/h2\u003e\u003cp\u003ePersonal encounters with cancer among philanthropists or their family members emerged as a powerful motivator for CSR giving. Such experiences often led donors to support less visible or stigmatized areas of care, including palliative services and patient support programs (\u003cb\u003eQ11\u003c/b\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThis qualitative study explored the dynamics of collaboration between corporate social responsibility (CSR) programs and cancer-focused non-governmental organizations (NGOs) in India. Using in-depth interviews with CSR heads and NGO representatives, the study examined how corporate funding priorities, operational processes, and partnership models shape the landscape of cancer philanthropy. The findings reveal an interplay between corporate visibility-driven motivations and NGO needs grounded in patient-centric service delivery.\u003c/p\u003e\u003cp\u003eA prominent theme emerging from the analysis was the \u003cem\u003eselective prioritization of funding areas\u003c/em\u003e. Corporations demonstrated a strong inclination to support pediatric cancer programs and curative treatment modalities, driven by higher survival rates and the emotional resonance of helping children. These initiatives were seen as opportunities to generate measurable outcomes and compelling narratives for CSR reporting. In contrast, adult cancer programs, preventive and screening activities, awareness generation, and community-level initiatives received limited attention. Palliative care, integral to comprehensive cancer management, was particularly marginalized, often misconstrued as \u0026ldquo;end-of-life care\u0026rdquo; with little scope for visible success. This underscores a broader pattern of \u0026ldquo;visibility over impact,\u0026rdquo; where short-term, tangible outcomes are favored over sustained investments in preventive and supportive care. Such practices, often termed bluewashing\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e, reflect a tendency among corporations to align CSR activities with brand enhancement and public image\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e rather than long-term health system strengthening.\u003c/p\u003e\u003cp\u003eThe study also identified multiple operational challenges that impede equitable access to CSR funding among NGOs. Smaller and community-based organizations frequently lacked the administrative capacity, proposal-writing skills, and documentation processes required to navigate the corporate funding environment. The bureaucratic and compliance-heavy nature of CSR reporting mechanisms created barriers that disproportionately affected grassroots NGOs. These challenges mirror patterns noted in other low-resource settings like Malawi and Ghana, where smaller NGOs struggled due to low resources for administrative and reporting demands by donors\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e. Additionally, a geographic concentration of CSR spending was observed, consistent with national data showing that a majority of CSR allocations are directed toward industrialized states such as Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Delhi, and Gujarat. This concentration reflects a misinterpretation of the CSR Act (2013), which recommends, but does not mandate, local area preference for CSR implementation. Consequently, NGOs operating in remote and underserved regions, where the burden of cancer is often higher and access to care lower, remain underfunded\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e. This urban bias in CSR allocation is similar to global funding trends. A study on the spatial analysis of aid distribution in 38 sub-Saharan African countries showed that philanthropic spending is concentrated in industrialized centres due to factors like population density, accessibility, and political prominence\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite these challenges, there exist opportunities for enhancing CSR impact. CSR funds have demonstrably reduced the financial burden on cancer patients, particularly through direct financial aid and support for treatment costs. Innovative partnership models and various initiatives by SBI, HDFC, Pfizer, Tata Trusts, etc, with like-minded organisations, demonstrate the potential for holistic funding for cancer care\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e. Support for lodging, nutritional needs, and educational continuity for patients and caregivers were identified as areas that can further expand the impact of CSR investment. Furthermore, larger NGOs partnered with nascent organisations to aid them in capacity building and funding. This offers a promising pathway to address geographical and capacity disparities.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePolicy recommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings of this study underscore the need for structural reforms to optimize the role of Corporate Social Responsibility (CSR) in strengthening cancer care delivery in India. Given the socioeconomic burden of cancer, policies should mandate that a defined fraction of CSR expenditure be allocated for cancer care. Policy frameworks should broaden the scope of eligible CSR activities to include preventive, palliative, and community-based interventions, along with essential operational and capacity-building costs such as staff salaries, training, and infrastructure maintenance. Recognizing these components as integral to effective cancer care would enable NGOs to sustain long-term, quality-driven programs rather than limiting CSR to short-term, highly visible interventions.\u003c/p\u003e\u003cp\u003eTo address the current concentration of CSR funding in urban and corporate-linked areas, policies should encourage geographic equity by incentivizing investments in underserved and rural regions. Mechanisms such as tax benefits, recognition schemes, or matching grants could be introduced to promote equitable distribution of resources. Further, CSR regulations should support multi-year commitments linked to measurable outcomes rather than annual expenditure cycles, enabling continuity of programs in areas such as research, patient support, and rehabilitation.\u003c/p\u003e\u003cp\u003eTo support newly established NGOs, CSR certification requirements should be revised and complemented with mechanisms that help credible new organisations access CSR funding. Simplifying compliance procedures and building the administrative capacity of smaller NGOs are also critical. National or state-level facilitation platforms could provide standardized templates, training modules, and certification support to help grassroots organizations meet CSR requirements. Streamlined reporting systems would reduce administrative burdens and promote efficiency. Additionally, the creation of centralized digital or regional platforms to connect corporates with credible NGOs in specific health domains could enhance transparency, reduce duplication, and ensure evidence-based resource allocation.\u003c/p\u003e\u003cp\u003eFinally, CSR contributions should be integrated within the framework of national cancer control strategies, such as the National Programme for Prevention and Control of Non-Communicable Diseases (NPNCD). Aligning corporate initiatives with public health priorities would ensure complementarity and long-term system strengthening. Beyond statutory compliance, corporates should be encouraged to adopt a compassionate and socially responsive approach that values equity, dignity, and sustainability. Promoting best practices and recognizing successful CSR\u0026ndash;NGO collaborations, particularly those addressing neglected or marginalized cancer populations, can help cultivate an ecosystem of responsible and inclusive health philanthropy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This study is among the few qualitative inquiries exploring the perspectives of both NGO representatives and CSR heads in the context of cancer care in India, providing a nuanced understanding of the dynamics shaping philanthropic and corporate engagement in health. The inclusion of participants from diverse organizational backgrounds, ranging from grassroots NGOs to corporate CSR divisions, enabled triangulation of perspectives and enriched the depth of analysis. However, the study\u0026rsquo;s findings are based on a relatively small, purposively selected sample and may not be generalizable to all CSR or NGO contexts beyond cancer care or beyond India. Since most interviews were conducted online, non-verbal cues and contextual nuances may have been partially missed. Additionally, participants\u0026rsquo; self-reported accounts may be influenced by social desirability or institutional affiliation, potentially introducing response bias. Finally, while triangulation among multiple coders enhanced consistency, the analysis may still reflect interpretive subjectivity inherent in qualitative research.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights the impact of CSR spending by corporate companies on cancer-focused NGOs in India, showing what hurdles non-profits navigate through when seeking CSR funding. While India\u0026rsquo;s mandatory CSR legislation has increased the investment for social development, its full potential in cancer care remains untapped due to misaligned priorities, geographic disparities, and administrative burdens. CSR must engage in equitable investments across the entire cancer care continuum that empower local NGOs and address pressing but often overlooked needs of patients. Future research should explore quantitative analysis of CSR spending trends on cancer care across geographical locations and years. Longitudinal studies should explore CSR-NGO partnerships and their long-term impact on cancer care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest:\u003c/h2\u003e\u003cp\u003eNil\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003ePersistent Foundation\u003c/p\u003e\u003cp\u003eStudy to be presented at ESMO Asia Congress 2025\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229\u0026ndash;263\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDonkor A, Atuwo-Ampoh VD, Yakanu F, Torgbenu E, Ameyaw EK, Kitson-Mills D et al (2022) Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis. 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Volunt Int J Volunt Nonprofit Organ 29(2):348\u0026ndash;360\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKermani F, Reandi STA Exploring the Funding Challenges Faced by Small NGOs: Perspectives from an Organization with Practical Experience of Working in Rural Malawi. Res Rep Trop Med 2023 Sept 1;14:99\u0026ndash;110\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCSR spending heavily concentrated in six states report flags neglect of underdeveloped regions [Internet]. [cited 2025 Dec 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.newindianexpress.com/nation/2025/Aug/08/csr-spending-heavily-concentrated-in-six-states-report-flags-neglect-of-underdeveloped-regions\u003c/span\u003e\u003cspan address=\"https://www.newindianexpress.com/nation/2025/Aug/08/csr-spending-heavily-concentrated-in-six-states-report-flags-neglect-of-underdeveloped-regions\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShon H, Lee H, Kim B (2024) Spatial pattern of aid allocation in the early 21st century: Evidence from 38 sub-Saharan African countries. Pap Reg Sci. June 1;103(3):100026\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Cancer Day (2023) : Top CSR projects catering to cancer patients in India - The CSR Journal [Internet]. [cited 2025 Dec 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://thecsrjournal.in/world-cancer-day-top-csr-projects-cancer-patients-india/\u003c/span\u003e\u003cspan address=\"https://thecsrjournal.in/world-cancer-day-top-csr-projects-cancer-patients-india/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8256379/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8256379/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePURPOSE\u003c/h2\u003e\u003cp\u003eOver 75% of Indian households affected by cancer face catastrophic health costs. Support from non-governmental organisations (NGOs) and corporate philanthropy, through initiatives such as Corporate Social Responsibility (CSR), which involves corporate funding for social development, helps address health disparities. This study explored factors influencing CSR spending on cancer projects and associated barriers and facilitators.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e\u003cp\u003eIn-depth semi-structured interviews were conducted with 15 NGO and 3 CSR stakeholders. Data were thematically analyzed using an inductive approach until saturation was reached.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e\u003cp\u003eParticipants indicated that CSR funding for cancer initiatives was affected by four factors: 1) misalignment between corporate priorities and NGO cancer care needs, 2) neglect of NGOs\u0026rsquo; operational and capacity-building costs, 3) businesses\u0026rsquo; preference for initiatives in their close vicinity, and 4) outcomes of the diseases. NGOs seeking CSR funding for cancer care faced barriers, including limited attention to sustainability and long-term impact; limited organisational capacity to meet communication, reporting, and administrative demands of CSR grants; and the competitive disadvantage of small or grassroot NGOs versus larger, well-established organisations. Despite these challenges, participants identified facilitators and opportunities to enhance CSR\u0026rsquo;s impact, such as adopting innovative partnership models between corporates and NGOs, extending CSR support to non-medical care costs like lodging, educational outreach and nutritional assistance, and fostering collaborations where established NGOs share CSR funds or expertise to support smaller organisations in joint cancer care projects and a tendency for companies to contribute when leaders or staff had personal or family experiences with cancer.\u003c/p\u003e\u003ch2\u003eCONCLUSION\u003c/h2\u003e\u003cp\u003eThis is the first qualitative study to highlight the determinants, barriers, and facilitators of CSR spending on cancer care in India. While India\u0026rsquo;s mandatory CSR legislation has increased investment in social development, its full potential in cancer care remains untapped.\u003c/p\u003e","manuscriptTitle":"The Role of Businesses in Supporting Non-Governmental Organisation for Cancer Care in India: Priorities, Barriers, and Facilitators","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 03:01:19","doi":"10.21203/rs.3.rs-8256379/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"82961119-6689-42b2-b1a7-c306ce826c80","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58932508,"name":"Oncology"}],"tags":[],"updatedAt":"2025-12-03T03:01:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-03 03:01:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8256379","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8256379","identity":"rs-8256379","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}