The Diagonal Approach to Health System Strengthening: A Roadmap for Expanding Access in LMICs August 28th, World Cancer Congress, Montreal

Transcription

1 The Diagonal Approach to Health System Strengthening: A Roadmap for Expanding Access in LMICs August 28th, 2012 World Cancer Congress, Montreal Felicia Marie Knaul, PhD Harvard Global Equity Initiative, Global Task Force on Expanded Access to Cancer Care and Control in LMICs Tómatelo a Pecho and Mexican Health Foundation UICC Board Member

2 From anecdote to evidence

3 January,(2008( June,(2007(

4 Juanita: Advanced metastatic breast cancer is the result of a series of missed opportunities to harness health systems using the diagonal approach

5 GTF.CCC Members!

6 Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries = global health + cancer care

7 Closing the Cancer Divide: A BLUEPRINT TO EXPAND ACCESS IN LMICs Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health

8 Challenge and disprove the myths about cancer/ncd/ Chronic illness Expanding access to cancer care and control in low and middle income countries: M1. Unnecessary M2. Unaffordable M3. Impossible M4: Inappropriate Should, Could, and Can.. be done

9 Women and mothers in LMICs face many risks through the life cycle Women 15-59, annual deaths - 35% in 30 years Mortality in childbirth Breast cancer Cervical cancer Diabetes 342, , , ,889 = 430, 210 deaths Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.

10 The Cancer Divide: An Equity Imperative Cancer is a disease of both rich and poor; yet it is increasingly the poor who suffer: 1. Exposure to risk factors Facets 2. Preventable cancers (infection) 3. Treatable cancers: death and disability 4. Stigma and discrimination 5. Avoidable pain and suffering

11 The Opportunity to Survive (M/I) Should Not Be Defined by Income 100% Children Adults Leukaemia All cancers Survival inequality gap LOW INCOME HIGH INCOME LOW INCOME HIGH INCOME In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%. Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

12 Cancer especially in Stigma: women and children - adds a layer of discrimination onto ethnicity, poverty, and gender. Survivorship care is nonexistent.

13 The most insidious injustice: lack of access to pain control! Non-methadone, Morphine Equivalent opioid consumption per death from HIV or cancer in pain: Poorest 10%: 54 mg per death Richest 10%: 97,400 mg per death

14 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. " Bridge the divide as patients suffer diseases over a lifetime, most of it chronic.

15 The diagonal approach: delivery and financing Ver=cal(Coverage(of(( Diseases(and(Interven=ons:(Benefits( Horizontal(Coverage:(Beneficiaries(

16 Diagonal Strategies: Positive Externalities " Promoting prevention and healthy lifestyles: " Reduces risk for cancer and many other diseases " Reducing stigma around women s cancers: " Reduces gender discrimination " Introducing cancer treatment for children " Improves hygiene and reduces intra-hospital infections " Promoting access to education for children w/ cancer " Reduces poverty, contributes to social development " Pain control and palliation " Reducing barriers to access is essential for cancer as well as for for other diseases and for surgery.

17 Diagonalizing Delivery: Delivery: Harness platforms by integrating breast and cervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/AIDS, social welfare and anti-poverty programs. Example: Mexico: integration of breast and cervical cancer awareness and screening into the national anti-poverty program Oportunidades

18 Diagonalizing Financing: Integrate cancer care and control into national insurance and social security programs to express previously suppressed demand beginning with cancers of women and children: " Mexico, Colombia, Dom Rep, Peru " China, India, Thailand " Rwanda, Ghana, South Africa

19 Investing in CCC: We Cannot Afford Not To " Health is an investment, not a cost " Economic cost of cancer, 2010: 2-4% of global GDP 1/3-1/2 of cancer deaths are avoidable : million deaths, 80% in LIMCs " Prevention and treatment offer potential, untapped world savings of $US billion " The costs of prevention and treatment are often less that many fear especially using a diagonal approach

20 Expanding CCC Necessary Affordable Possible Appropriate

21 Be an optimalist optimist Expanding access to cancer care and control in LMICs: Should, Could, and Can be done