ADVOCACY: MSD – Integrating cancer care with universal health coverage: best practices and challenges for implementing National Cancer Control Plans
By investing in evidence-based NCCPs, countries can develop context-specific, strategic approaches to integrate cancer interventions within existing health services and ensure equitable access to cancer care
The global burden of cancer is sharply rising, with an estimated 20 million new cases of cancer and 10 million deaths attributed to cancer in 2020.1 The cancer burden is estimated to increase by 60% over the next two decades, with the predicted global burden increasing to 30 million new cancer cases by 2040.2 Indeed, most G20 countries experience high proportional mortality from non-communicable diseases exceeding 70%.3 Success in addressing cancer can pave the way for progress of these countries in addressing the growing morbidity and mortality from other NCDs by addressing common risk factors and improving the overall health system.
Given that an estimated 40% of cancers are preventable4 and a further third of cancers can be cured through early detection and proper treatment,5 investment in cancer control programmes has a strong imperative. It is critical that countries integrate regional or national cancer control plans within universal health coverage schemes. By investing in the development, implementation and evaluation of evidence-based National Cancer Control Plans, countries can develop context-specific, strategic approaches to integrate priority cancer interventions and ensure that all patients can access the right care.
NCCP best practices
While several best practices can be gleaned from countries with well-implemented NCCPs, two are particularly relevant as countries move towards UHC. Other countries, particularly resource-limited countries, can learn from these best practices while encouraging all-inclusive population coverage in progress towards UHC.
Firstly, countries have established an institution to lead cancer control at the national or regional levels to establish ownership, accountability and follow-through for the development and implementation of NCCPs. Notably, France’s first cancer plan – championed by Jacques Chirac – established the National Cancer Institute (INCa) in 2004 to coordinate cancer control functions at the national level. To the present day, INCa coordinates all actions related to the development, evaluation and implementation of France’s NCCPs, resulting in the recently updated national cancer strategy (2021–2030).6,7
Secondly, countries have leveraged long-term partnerships with multilateral institutions and international cancer specialists to continually assess national cancer control capacities and to strengthen their NCCPs within the context of available resources. In 2022, Uzbekistan underwent an imPACT review8 to assess its national cancer system capabilities. It received technical advice and support from long-term partners including the International Atomic Energy Agency, the World Health Organization, International Agency for Research on Cancer and the Islamic Development Bank to align its new NCCP with key national health policies, country-specific cancer data and the country’s socio-economic context.9
Challenges to NCCPs
However, there are significant discrepancies among countries with respect to development and implementation of NCCPs. Two main reasons for this are lack of political will and underfunding.10 These challenges act as barriers to effective NCCP formulation and integration of national cancer plans with UHC plans.
In many countries, cancer care is not a priority for the public system, nor for political leadership. Strong political will is needed to drive multi- and cross-sector collaboration among government policymakers, healthcare workers, academia and patient groups. Inadequate financial resources allocated to NCCPs is a critical limiting factor for many G20 countries, irrespective of their income levels.5,11
Approaching NCCP challenges
Countries should pursue two critical actions to address challenges to NCCP formulation and implementation in order to ensure access to quality cancer care for all populations.
Countries must encourage the participation of a cross-sectoral group of stakeholders – including government, private, civil society and multilateral sectors – to develop, finance and implement NCCPs.
Comprehensive and context-specific NCCP development and implementation is dependent upon active participation across patients, payers, providers and other key stakeholders in the cancer care system and active support from political leadership. This is especially important for aligning cancer plans with UHC. Morocco successfully became the first North African country with a NCCP in 2010 following active cross-sector mobilisation under the patronage of Princess Lalla Salma.12 The US Cancer Moonshot13 and Europe’s Beating Cancer Plan14 are also testaments to strong political leadership on cancer.
Countries must invest in the implementation and expansion of health information systems for cancer control decision-making.
Investments in building or improving information systems – including population- and hospital-based cancer registries – are needed to leverage timely epidemiological cancer data, appropriately set and monitor health priorities and identify feasible, cost-effective interventions. Countries, particularly resource-limited ones, can draw upon technical resources developed by multilateral partners – such as the WHO’s Best Buys for NCDs – to invest in the most effective cancer interventions for its populations. The development of the National Cancer Database for Cost and Quality of Life in India is an important tool for informing cancer-specific health benefits packages under publicly financed health insurance schemes, as well as understanding cost-effectiveness of available cancer interventions. It is critical to ensure that cancer interventions are cost-effective, affordable and integrated into health benefits packages under UHC.15
Call to Action
Countries must invest in developing, implementing, monitoring and financing evidence-based NCCPs to drive efficient and effective action on cancer care to improve outcomes. Countries must also strategically prioritise cancer interventions within UHC plans to ensure equitable health access for a rising number of cancer patients worldwide.16
References
1. WHO International Agency for Research on Cancer. 2020. Estimated number of deaths in 2020, all cancers, both sexes, all ages. Cancer Today.
2 WHO PAHO. World Cancer Day 2023: Close the care gap.
3 Akashi H., et al. 2019. The role of G20 economies in global health. Glob Health Med, 1(1): 11-15.
4 The Lancet. 2023. Global cancer: overcoming the narratives of despondency. The Lancet, 401(10374): p319.
5 Union for International Cancer Control. 2023. Why Cancer? World Cancer Day
6 Jelenc M., Albreht T., et al. 2021. Policy Paper on National Cancer Control Programmes (NCCPs)/ Cancer Documents in Europe. Cancer Control.
7 International Cancer Control Partnership. 2021. New NCCP in France and Europe’s Beating Cancer Plan.
8 Veljkovikj I., et al. 2022. Evolution of the joint International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC), and WHO cancer control assessments (imPACT Reviews). The Lancet Oncology, 23(10): e459-468.
9 IAEA. 2022. IAEA, WHO and IARC Conduct Assessment to Inform Further Investments in Cancer Care in Uzbekistan.
10 Romero Y., et al. 2018. National cancer control plans: a global analysis. The Lancet Oncology 19(10): e546-555,
11 Jelenc M., et al. 2021. Developments in National Cancer Control Programmes for Europe – Results from the Analysis of a Pan-European Survey. Cancer Control.
12 Selmouni F., et al. 2018. Tackling cancer burden in low-income and middle-income countries: Morocco as an exemplar. The Lancet Oncology 19: e93-101.
13 United States National Cancer Institute. 2023. Cancer Moonshot.
14 European Commission. 2022. A cancer plan for Europe.
15 Prinja S., et al. 2021. Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol. BMJ Open 11(7): e048513.
16 WHO. 2023. SDG Target 3.4.
