The Diagonal Approach to Health System Strengthening: A Roadmap for - - PowerPoint PPT Presentation

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 2012-14

From anecdote …

… to evidence

January,(2008( June,(2007(

Juanita:

Advanced metastatic breast cancer is the result of a series of missed

• pportunities to harness health systems

using the diagonal approach

GTF.CCC

Members!

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

= global health + cancer care

Applies a diagonal approach to avoid the false dilemmas between disease silos

• CD/NCD- that

continue to plague global health

Closing the Cancer Divide:

A BLUEPRINT TO EXPAND ACCESS IN LMICs

Challenge and disprove the myths about cancer/NCD/ Chronic illness

• M1. Unnecessary
• M2. Unaffordable
• M3. Impossible

M4: Inappropriate

• Should,
• Could, and
• Can…..

be done Expanding access to cancer care and control in low and middle income countries:

Women and mothers in LMICs face many risks through the life cycle Women 15-59, annual deaths

Diabetes

120,889

Breast cancer

166,577

Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.

Cervical cancer

142,744

Mortality in childbirth

342,900

• 35%

in 30 years

= 430, 210 deaths

Cancer is a disease of both rich and poor; yet it is increasingly the poor who suffer:

• 1. Exposure to risk factors
• 2. Preventable cancers (infection)
• 3. Treatable cancers: death and disability
• 4. Stigma and discrimination
• 5. Avoidable pain and suffering

The Cancer Divide: An Equity Imperative

Facets

Adults

Leukaemia

All cancers

Source: Knaul, Arreola, Mendez. estimates based on IARC, Globocan, 2010.

Children

LOW INCOME HIGH INCOME

Survival inequality gap

LOW INCOME HIGH INCOME 100%

The Opportunity to Survive (M/I) Should Not Be Defined by Income

In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.

Stigma:

Cancer – especially in women and children - adds a layer of discrimination onto ethnicity, poverty, and gender. Survivorship care is non- existent.

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

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

• pportunities 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.

Horizontal(Coverage:(Beneficiaries( Ver=cal(Coverage(of(( Diseases(and(Interven=ons:(Benefits(

The diagonal approach: delivery and financing

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.

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

‘Diagonalizing’ Delivery:

‘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

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”: 2.4-3.7 million deaths, 80% in LIMCs

" Prevention and treatment offer potential, untapped world savings of $US 100-200 billion " The costs of prevention and treatment are often less that many fear especially using a diagonal approach

Necessary……

• Affordable
• Possible
• Appropriate

Expanding CCC

Be an

• ptimalist
• ptimist

Expanding access to cancer care and control in LMICs: Should, Could, and Can be done