Professional Documents
Culture Documents
Global Health Governance and Financing for Endemic NCDs Boston, MA March 3, 2011
Mandate: Design, develop and implement global, regional and local strategies to improve the financing, procurement and delivery of cancer care, control, treatment and palliation in a sustainable 27 members manner applying innovative representing the global health and service delivery models appropriate to health systems cancer in the developing world. communities
Convened in Nov 2009 By HSPH, HMS, HGEI, DFCI Co-Chaired: L Shulman, J Frenk
White Paper for policy and strategy & Lancet Commission Report
More than 85% of pediatric cancer cases and 95% of deaths occur in developing countries that use less than 5% of the world resources.
For children & adolescents 5-14 cancer is
#2 cause of death in wealthy countries
The opportunity to survive should not be an accident of geography or defined by income. Yet it is. But . there is scope for action.
0.8
73%
Leukaemia, <15
0.6
0.4
0.2
0
Low income countries Lower middle income Upper middle income High income countries
Source: Author estimates based on IARC, Globocan, 2008 and 2010. Quote: HRH Princess Dina Mired
Lethality gap
Cancers that can be prevented (e.g. cervical) Cancers that can be detected early and cured (e.g. breast) Cancers that can be treated successfully (e.g. LLA children, testicular)
Death from preventable and treatable cancer is more exclusive to the poor Avoidable pain and suffering particularly at end of life is only permitted for the poor Financial impoverishment from the costs of care and effects of the disease is concentrated among the poor
abandon therapy 2%
cured 83%
Peru, Lima: All patients initiated with at least 4 months therapy between Aug 96 and Feb 99
Mitnick et al, Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. NEJM 2003; 348(2): 119-28.
Models:
ACCESS QUALITY
FINANCIAL PROTECTION
Low-income: Rwanda-Malawi-Haiti
Embryonal Rhabdomyosarcoma
3. Package of personal health services based on costeffectiveness and burden of disease expands over time
Chronic
AIDS, Cervical cancer, TB, liver cancer, Chagas, cardiopathy, rheumatic heart disease, gastric cancer,
Acute
Africa
207,000
LMICs
355,000
effective approach is to deliver health interventions: vertical programs or horizontal programs. This is a false dilemma, because both interventions need to coexist in what could be called a diagonal approach
Seplveda et al., Aumento de la sobrevida en menores de 5 aos: la estrategia diagonal
Diagonal approaches
1. Financial protection/insurance strategies with horizontal and vertical coverage 2. Integrating breast and cervical cancer screening into MCH, SRH 3. Integrating disease prevention and management into social welfare and antipoverty programs 4. Catalyzing and employing community health workers and expert patients 5. Reducing non-price barriers to pain control 6. Developing effective health services research and monitoring
Global Health Governance and Financing for NCDs of the poorest: Lessons from Expanding Access to Cancer Care and Control in LMICs
Felicia Marie Knaul
Director, Harvard Global Equity Initiative Secretariat, Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries Associate Professor, Harvard Medical School
Global Health Governance and Financing for Endemic NCDs Boston, MA March 3, 2011