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24 February 2022

Improving cancer care in Latin America for all populations

A series of four in-depth reports on the health system challenges in managing cancer in Argentina, Brazil, Chile and Colombia offer a comprehensive review and health system solutions to improve access to care.

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The Integrated Cancer Control Initiative in Latin America (ICCI-LA) was launched in 2019 following discussions between Dr Eduardo Cazap, former UICC president and founder and first President of the Latin American & Caribbean Society of Medical Oncology (SLACOM) and Dr Rifat Atun, Professor of Global Health Systems at Harvard University, as well as UICC Board Members, member organisations and partners, including Novartis.

The objective was to develop a methodology to examine all aspects of the cancer burden and the health system challenges to manage this burden in Latin America, in order to design effective solutions that take into account financial, regulatory and technical resources.

Argentina, Brazil, Chile and Colombia cover the spectrum of large, medium and smaller population countries, with a range of government and governance structures, and different health systems. Combined, they represent about half of the region’s population as well as a significant proportion of the cancer burden cancer in Latin America and the Caribbean (60% of new cases each year and 58% of cancer-related mortality). 

These four countries represent many characteristics that are common to the Latin American and Caribbean region as a whole. The reports provide a comprehensive picture of the health system challenges shared by many countries in the region in managing cancer and provide solutions that can be applied in most settings.

From analysis to insights

“Methodology is very important. Identifying barriers is one thing but a systematic process is required to arrive at accurate conclusions and observations. We established a very rigorous and thorough four-step methodology that included a review of the literature, a survey of multiple stakeholders, a series of roundtables with experts in different fields identifying challenges and looking not only at solutions but how they can be implemented, and finally identifying priorities and issuing proposed policies.”
–    Dr Rifat Atun, Professor of Global Health Systems at Harvard University, Co-Chair of the ICCI-LA Global Steering Committee

The review of published documents on the burden of cancer, the determinants of cancer, as well as the trends for incidence, prevalence, survival and mortality for cancer, provided initial insight into the contextual and systemic challenges facing healthcare systems as well as cancer-specific issues. 

The second step of the process, however, went beyond the sole focus on cancer to identify organisational and governance issues in healthcare systems that affect the allocation and management of financing and resources for cancer control. The process involved surveying key informants and was highly inclusive, encompassing not only ministries of health but also members of parliament and policymakers in cross-cutting sectors, as well as private sector funders, civil society, patient groups, academics and clinicians. 

A key problem perceived in all countries, according to Dr Atun, was the fragmentation of the health system. This leads to inequitable and inefficient cancer care and poorly integrated data systems that are unable to provide the necessary intelligence to monitor health system performance and set priorities for cancer. “In Chile, there’s a suboptimal interaction between public and private sectors, in Brazil also, where the decentralised system often makes coordinated decision-making more difficult. Argentina and Colombia both show a fragmentation of data systems and healthcare providers that undermines attempts at a unified approach to management of cancer,” said Dr Atun, a member of the ICCI-LA Global Steering Committee. 

Other common features of the four countries studied include the presence of existing cancer laws or policies but a lack of allocated budget to implement them, as well as reliable data and an operative, budgeted, active and updated national cancer control plan.

“Effective cancer control is often not a question of lack of resources but the poor allocation of resources due to systemic issues in the design of health systems, a poor definition of priorities and lack of political will. That said, I think we will see improvements in allocation in the years to come.” 
Dr Eduardo Cazap, former UICC president and founder and first President of the Latin American & Caribbean Society of Medical Oncology (SLACOM), Co-Chair of the ICCI-LA Global Steering Committee

Dr Cazap also emphasised the lack of equity in accessing care for many populations in all countries, including the most vulnerable and marginalised, such as indigenous peoples, refugees, people who live in remote areas or who are from low socioeconomic backgrounds and who have particular needs in terms of prevention and early detection due to ethnic or genetic predispositions to certain cancers, as well as certain cultural sensitivities, which are not being met.

Dr Atun said that the governments had been very responsive to the work and conclusions of the reports by ICCI-LA. In Chile, for example, the process was highly inclusive, with a strong engagement of all the stakeholder groups and the Ministry of Health to develop solutions to effectively address the challenges identified, in Argentina there were several follow-up events to work on implementation, in Colombia the local ICCI-LA team has developed a series of marketing assets to communicate the findings in the country report, and in Brazil, in Rio Grande do Sul, an “innovation lab” is being established to translate policy recommendations into action to improve cancer care and reduce incidence and mortality.

“Health systems have been designed around diseases; they need to be designed for individuals. What we propose to build is not a system for cancer care but a health system to effectively support people with cancer. If the health system is fixed, everyone benefits.”
Dr Rifat Atun, Professor of Global Health Systems at Harvard University, Member of the ICCI-LA Global Steering Committee

ICCI-LA is overseen by a Global Steering Committee whose membership includes researchers and professionals from Harvard University, UICC, the Latin American and Caribbean Society of Medical Oncology (SLACOM) and the University of Miami. Funding for ICCI-LA is provided through an unrestricted grant by Novartis to UICC.

Last update

Thursday 24 February 2022

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