In low-income countries, the increased cancer burden cannot be tackled by the local health system, which currently works at a mean capacity of 10% of what is required. Low-income countries are also characterized by a lack of access to basic subsidized chemotherapy, as seen in figure 1. This means that millions of people are dying due to lack of access to quality cancer care, which is basic in high-income countries.
Figure 1 – Access to basic subsidized chemotherapy:
The Organization for Economic Co-operation and Development (OECD) is an intergovernmental economic organization with 36-member countries, founded in 1961 to stimulate economic progress and world trade. According to the OECD, there are three important pillars in cancer care:
Figure 2 – Value of cancer prevention and control:
In high-income countries, total health expenditure per capita is around 4800 USD with the government funding approximately 60% of it. In middle-income countries, the health expenditure per capita is around 90 USD with the government funding only 36% (100 times lower budget and very high out of pocket expenditure demanded by the patients). This results in a tremendous financial burden on the patients, leading to commonly witnessed financial catastrophes, and high levels of inequity, since the government pays only for a select group of patients.
In some of the low and middle-income countries, despite having a screening program for certain cancer, the common treatment options are not available. This creates significant inefficient expenditures. There is also a problem of biased inputs in priority setting, and no cost containment mechanism, all leading to inefficient expenditures.
The possible solutions for these challenges include improving cancer planning, anticipating budget changes/ cost drivers, and use the WHO tool to set priorities based on impact, cost and feasibility to build a high-quality health system. According to WHO, health quality is based on optimal effectiveness, efficiency, accessibility, patient-centered system, equality, and safety. Centralization is also a key component. Facilities need to be centralized, and centers of excellence need to be developed so that they learn and adapt to high volumes, with the final goal leading to improved outcomes. Furthermore, providers need to be accredited as well. Residency, fellowships and specialization programs need to be created, monitored and updated. The coordination and referral mechanism between centers need to be improved, and the workforce needs to be optimized. Guidelines should be used to standardize outcomes and improve equity and reduce costs. Country-specific standards need to be developed and monitored including quality standards.
In summary, in this talk, Dr. Ilbawi explained why cancer is critical in the public health agenda and the political arena. The Burden of cancer is on the rise, especially in straining populations and low-income economies around the world. Cancer programs must be founded on scientific evidence, system capacity and budgetary impact. Investing in the quality of the health workforce is mandatory and critical for the successful control of cancer.
Presented By: André Ilbawi, MD, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23, 2018, Munich Germany
- Governance - National Cancer Control Program (NCCP) should be created to decide on targets, timeframe, case management, and networks
- Practice – Short referral and waiting times, adherence to professional guidelines, and reaching optimal treatment, implementation of cancer screening programs
- Resources – National expenditure, number of CT scanners, and the number of cancer centers per the population
- - Only 1/5 countries have the necessary required resources to assess the required data
- - There is also a weak correlation between program selection and the burden or the health system capacity.
- - Only 10% have the budget that can realistically be associated with the plan
- - Only 7% have some sort of monitoring mechanism
- Political and legal landscape
- A working health system
- A care pathway
- Patients and providers
Figure 2 – Value of cancer prevention and control:
In high-income countries, total health expenditure per capita is around 4800 USD with the government funding approximately 60% of it. In middle-income countries, the health expenditure per capita is around 90 USD with the government funding only 36% (100 times lower budget and very high out of pocket expenditure demanded by the patients). This results in a tremendous financial burden on the patients, leading to commonly witnessed financial catastrophes, and high levels of inequity, since the government pays only for a select group of patients.
In some of the low and middle-income countries, despite having a screening program for certain cancer, the common treatment options are not available. This creates significant inefficient expenditures. There is also a problem of biased inputs in priority setting, and no cost containment mechanism, all leading to inefficient expenditures.
The possible solutions for these challenges include improving cancer planning, anticipating budget changes/ cost drivers, and use the WHO tool to set priorities based on impact, cost and feasibility to build a high-quality health system. According to WHO, health quality is based on optimal effectiveness, efficiency, accessibility, patient-centered system, equality, and safety. Centralization is also a key component. Facilities need to be centralized, and centers of excellence need to be developed so that they learn and adapt to high volumes, with the final goal leading to improved outcomes. Furthermore, providers need to be accredited as well. Residency, fellowships and specialization programs need to be created, monitored and updated. The coordination and referral mechanism between centers need to be improved, and the workforce needs to be optimized. Guidelines should be used to standardize outcomes and improve equity and reduce costs. Country-specific standards need to be developed and monitored including quality standards.
In summary, in this talk, Dr. Ilbawi explained why cancer is critical in the public health agenda and the political arena. The Burden of cancer is on the rise, especially in straining populations and low-income economies around the world. Cancer programs must be founded on scientific evidence, system capacity and budgetary impact. Investing in the quality of the health workforce is mandatory and critical for the successful control of cancer.
Presented By: André Ilbawi, MD, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23, 2018, Munich Germany