Expanding Access to Cancer Care and Control: Systemic therapy

Felicia Marie Knaul Harvard Global Equity Initiative, Global Task Force on el estilo de subttulo del Haga clic para modificar Expanded Acces to CCC Mexican Health Foundation patrn Tmatelo a pecho
National Cancer Institute, Center for Global Health, National Institutes of Health

Setting priorities for global cancer research

March 13-14, 2012

4/18/12

4/18/12

Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries

= global health + cancer care

Haga clic para modificar el estilo de subttulo del patrn

Closing the Cancer Divide:

A Blueprint to Expand Access in Low & Middle Income Countries

4/18/12

Challenge and disprove the myths about cancer

Expanding access to cancer care and control in low and middle income countries: M1. Unnecessary M2. Inappropriate M3. Unaffordable M4. Impossible

Should,

Could, and Can.. .be done

4/18/12

Epi transition: Cancer is becoming a leading cause of childhood death

5-14: % of total mortality, Mexico, 1979-2008 M. tumors
Res infs Inf + parasitic

In Canada, almost 90% of children with leukemia can hope to survive. In 4/18/12 the poorest 25 countries, only 10%.

19 79

20 08

Cancer, 5-14: - 3rd leading cause in upper middle income, 4th in lower middle, 8th in low income countries.

The Cancer Transition, A measure of success: breast and cervical cancer, mortality time series.
1 6
Adjusted age rate x 100,000 women

MEXICO

0 19 85 19 55 20 05

Source: Instituto Nacional de Estadstica y Censos, Ministerio de Salud, Unidad de Estadstica, Registro Nacional de Tumores de Costa Rica.

4/18/12

20 10

The costs of meds to close the cancer divide is less than many fear:
All but 3 of 29 LMIC priority, candidate cancer chemo and hormonal agents are off-patent: many < $100 / course Cost of drug treatment cervical cancer + HL + ALL(k) in LMICs / year of incident cases: $US 280 m

Supportive care meds are not necessarily costly Prices drop:

HPV 2011: $US 100 /dose to GAVI $5 & PAHO $14

4/18/12

We cannot afford not to health is an investment not a cost.

Getting ST effectively to the (right) people

Primary and secondary prevention (early detection) Accurate diagnosis: lab and pathology services Comprehensive package supportive care meds Surgery and RT Specialized oncologists and other medical personnel Accompaniment for adherence to treatment

technology to source global resources, be resourceful with domestic HR. 4/18/12

Harness Long term follow up existing platforms, use

The Diagonal Approach to Health System Strengthening

Rather than focusing on disease-specific vertical programs or only on horizontal system constraints, harness synergies that provide opportunities to tackle disease-specific priorities while addressing systemic gaps. Optimize available resources so that the whole is more than the sum of the parts. Example: training health promoters, controlling intra-hospital infections reducing stigma and 4/18/12

Regional and Global Financing: potential

Aggregate purchasing and sustainable procurement through existing funds and platforms
UNICEF PAHO

Diagonal partnership initiatives pink ribbon red ribbon

4/18/12

Financing innovations: Domestic

Integrate CCC into national insurance programs to express previously suppressed demand, beginning with cancers of women and children: Mexico, Colombia, Dominican Republic, Peru China, India, Taiwan Rwanda, Kenya

4/18/12

Mexico, Seguro Popular and cancer:

Accelerated, universal, coverage by disease with an ample package of interventions

(e.g. Herceptin)

4/18/12

Expansion: between 2005 and 2011 childhood, cervical, How to expand? NHL, breast, testicular cancer,
Diseases or interventions

Barriers and solutions to access systemic therapy: breast cancer, Mexico

Barrier 1: financing for treatment
Seguro Popular

Barrier 2: lack of information, machismo, stigma

Harness large-scale anti-poverty, womens health programs Oportunidades

Barrier 3: Treatment-associated costs: travel, supportive care and caregiving

CT at secondary-level hospitals linked to tertiary centers

Barrier 4: Longer-term treatment and survivorship?? Qualitative, patient journey analysis National Health Surveys 4/18/12 Evaluation of impact (process)

Strengthening the evidence

Global health research
How to harness and catalyze institutions for procurement and purchasing

Delivery methods and regime innovations Health systems research designs for improving stewardship, delivery, financing and strengthening human resources Implementation and evaluation research:
What works?

Identifying barriers supply and demand

4/18/12

Impact of stigma and discrimination

Translating and applying the evidence to evoke action

Collaborative, evidence-based advocacy to harness global institutions Better and more data collected in efficient ways Metrics for decision-making, monitoring and evaluation of progress CE analysis Stratified guidelines Reviews and recommendations for treatment innovations conduct clinical trials to inform global decision-making Sharing results through common platforms
Results Bank for health systems and implementation research Global 4/18/12 virtual forum for exchange

Expanding Access to Cancer Care and Control: Systemic therapy

Felicia Marie Knaul Harvard Global Equity Initiative, Global Task Force on el estilo de subttulo del Haga clic para modificar Expanded Acces to CCC Mexican Health Foundation patrn Tmatelo a pecho
National Cancer Institute, Center for Global Health, National Institutes of Health

Setting priorities for global cancer research

March 13-14, 2012

4/18/12