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Hussein K, Wafula F, Kassie GM, Kokwaro G. Barriers and facilitators to implementation of the Ethiopian national cancer control plan strategies: Implications for cervical cancer services in Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003500. [PMID: 39037972 PMCID: PMC11262691 DOI: 10.1371/journal.pgph.0003500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/25/2024] [Indexed: 07/24/2024]
Abstract
Following an upsurge in cervical cancer incidence and mortality, Ethiopia developed its first National Cancer Control Plan (NCCP) to support efforts toward the prevention and control of cancer. The NCCP outlines strategies for reducing the incidence of cancer through prevention, screening, early diagnosis, treatment, and palliative care. This study examined barriers and facilitators to the implementation of the NCCP using a qualitative approach. The study entailed doing key informant interviews and reviewing secondary data. Using customized topic guidelines, fifteen interviews were conducted covering a wide range of topics, including political commitment, priority setting, interagency cooperation, the role of evidence, citizen empowerment, and incentives. All interviews were recorded (with consent), transcribed in Amharic, and then translated into English for thematic analysis. Review of secondary data focused on establishing the NCCP's implementation status for HPV vaccination, cervical cancer screening, and treatment, and strategic links to five other national policy documents centered on public awareness, cervical cancer services, HPV immunization, and sexually transmitted infections control. We found that in 2022, 55% of eligible Ethiopian women were screened for cervical cancer (against the annual target), with roughly half of those with a positive result receiving treatment. Overall, 900,000 (8.4%) of the 10.7 million eligible women in the country underwent screening. The study revealed inadequate implementation of the NCCP strategies toward achieving the WHO's 90-70-90 cervical cancer targets by 2030. A key positive strategy was the involvement of high-ranking government officials in the National Cancer Committee, which aided the NCCP implementation. On the other hand, inadequate political support, funding constraints, suboptimal public messaging, lack of incentives, and inadequate partnership arrangements emerged as important barriers. We recommend that decision-makers intensify coordinated efforts, prioritize dealing with identified challenges and optimizing facilitators, and mobilize additional resources to enhance cervical cancer services in Ethiopia.
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Affiliation(s)
- Kemal Hussein
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Getnet Mitike Kassie
- International Institute for Primary Healthcare–Ethiopia (IPHC-E), Addis Ababa, Ethiopia
| | - Gilbert Kokwaro
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
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Bolous NS, Chokwenda-Makore N, Bonilla M, Chingo G, Kambugu J, Mulindwa JM, Noleb M, Chitsike I, Bhakta N. Addressing the gap in health economics data to support national cancer control plans in low- and middle-income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) tool. Cancer 2024; 130:1112-1124. [PMID: 38100617 DOI: 10.1002/cncr.35146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND National cancer control plans (NCCPs) are complex public health programs that incorporate evidence-based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context-specific national budget to fund pediatric cancer programs, provides 5-year scale-up scenarios, and calculates annual cost-effectiveness. METHODS The tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real-world data, modeled data, and data from the literature. A base-case and three 5-year scale-up scenarios were created using modifiable inputs. The cost-effectiveness of the disability-adjusted life years averted was calculated. Results were compared with each country's projected gross domestic product per capita for 2022 through 2026. RESULTS The number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base-case cost per disability-adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda. CONCLUSIONS This costing tool provided a framework to forecast a budget for childhood-specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6 years of planning processes.
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Affiliation(s)
- Nancy S Bolous
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nester Chokwenda-Makore
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Miguel Bonilla
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Grace Chingo
- Department of Pediatric Oncology, Cancer Disease Hospital, Lusaka, Zambia
| | - Joyce Kambugu
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Justin M Mulindwa
- Department of Pediatric Oncology, Cancer Disease Hospital, Lusaka, Zambia
| | - Mugisha Noleb
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Inam Chitsike
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Meyer S, Harries J, Torode J, Baldwin-Ragaven L. Harnessing the law to advance equitable cancer care in South Africa: exploring the feasibility, desirability and added value of a dedicated national cancer act. Ecancermedicalscience 2024; 18:1658. [PMID: 38425764 PMCID: PMC10901632 DOI: 10.3332/ecancer.2024.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Indexed: 03/02/2024] Open
Abstract
Background The 2017 World Health Assembly resolution on integrated cancer prevention and control provided clear guidance on creating an enabling environment for cancer care. Through a variety of mechanisms, including civil society advocacy, some countries have secured overarching legislation in the form of national cancer acts to promote equitable access and outcomes for cancer patients. In South Africa, cancer incidence is set to double by 2030; and, while existing legislative and policy frameworks do address cancer prevention and control, these are fragmented, poorly implemented and have had limited success. Methods This study assessed the feasibility and potential impact of promulgating a dedicated national cancer act in South Africa through exploratory in-depth interviews with 25 purposively selected key informants from various stakeholder groups, including cancer survivors; legal scholars; human rights advocates; health care providers; public health specialists and academicians. Findings Following thematic analysis, three key themes were identified: the content of a dedicated national cancer act, the socio-political leveragability of an act and accountability mechanisms that would support such an act. Conclusion While most respondents had not considered the possibility of a dedicated national cancer act, they were open to the concept for South Africa. Concerns about widening inequities, duplication, funding and accountability would need to be addressed against the current backdrop of health inequities and limited human rights leveraging for health.
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Affiliation(s)
- Salomé Meyer
- Cancer Alliance, Netcare Rehabilitation Hospital, 2 Bunting Road, Auckland Park, Johannesburg 2092, Gauteng, South Africa
- https://orcid.org/0009-0006-5624-8170
| | - Jane Harries
- Cancer Association of South Africa (CANSA), 26 Concorde Road West, Bedfordview 2008, Gauteng, South Africa
- https://orcid.org/0000-0001-7359-8419
| | - Julie Torode
- Global Health Unit, Institute of Cancer Policy, Kings College London. Strand, WC2R 2LS London, UK
- https://orcid.org/0000-0002-9755-3968
| | - Laurel Baldwin-Ragaven
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
- http://orcid.org/0000-0002-6744-3768
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Chaji D, Boltong A, Der Vartanian C, Lambert A, Toms C, Milch V, Howlett C, Keefe D. Setting the policy agenda for cancer control reform: Australia's first national cancer control plan. Med J Aust 2023; 219:451-454. [PMID: 37925168 DOI: 10.5694/mja2.52120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/18/2023] [Indexed: 11/06/2023]
Affiliation(s)
| | - Anna Boltong
- Cancer Australia, Sydney, NSW
- Kirby Institute, UNSW Sydney, Sydney, NSW
| | | | | | | | - Vivienne Milch
- Cancer Australia, Sydney, NSW
- Caring Futures Institute, Flinders University, Adelaide, SA
| | | | - Dorothy Keefe
- Cancer Australia, Sydney, NSW
- Adelaide Medical School, University of Adelaide, Adelaide, SA
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Mullen L, Signorelli C, Nekhlyudov L, Jacobsen PB, Gitonga I, Estapé T, Lim Høeg B, Miles A, Sade C, Mazariego C, Degi CL, Howard F, Manne S, Travado L, Jefford M. Psychosocial care for cancer survivors: A global review of national cancer control plans. Psychooncology 2023; 32:1684-1693. [PMID: 37749754 DOI: 10.1002/pon.6218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE National Cancer Control Plans (NCCPs) are high-level policy documents that prioritise actions to be taken to improve cancer control activities. As the number of cancer survivors grows globally, there is an urgent need to assess whether and how psychosocial care across the cancer care continuum is included in NCCPs. This review aimed to ascertain the extent to which NCCPs referenced psycho-oncology care for cancer survivors in the post-treatment phase. METHODS NCCPs were obtained from the International Cancer Control Partnership (ICCP) portal (in November 2021) and reviewed in two phases. In Phase 1, all available NCCPs were screened to determine whether they mentioned psycho-oncology or survivorship. In Phase 2, reviewers extracted data from the NCCPs identified in Phase 1 on the degree that each plan articulated objectives/goals to improve psychosocial care in the post-treatment survivorship phase. RESULTS We screened 237 NCCPs. Of these, initial potential reference to psycho-oncology and survivorship content were identified in 97 plans (41%). In Phase 1, 57/97 (59%) had reference to psycho-oncology or survivorship content within defined criteria. In Phase 2, 27/97 (28%) had little mention of psycho-oncology specifically in survivorship, 47/97 (48%) had some (general or brief) mention, and the remaining 23/97 (24%) had substantial content/specific sections and clearly articulated goals and/or objectives. Common goals for improving psychosocial care in the post-treatment period included building capacity of healthcare professionals, implementing rehabilitation models, and increasing the utilisation of community services. CONCLUSIONS Most NCCPs did not reference psycho-oncology and only one-quarter contained clear objectives specifically in the post-treatment survivorship phase.
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Affiliation(s)
- Louise Mullen
- National Cancer Control Programme, Health Services Executive. Kings Inns House, Dublin, Ireland
| | - Christina Signorelli
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Randwick, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul B Jacobsen
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Isaiah Gitonga
- Department of Psychology, Maynooth University, Dublin, Ireland
- Ikuze Africa, Nairobi, Kenya
| | - Tania Estapé
- Psychosocial Oncology Department, FEFOC Foundation, Barcelona, Spain
| | - Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Cristina Sade
- Psychosocial Oncology Department, Instituto Nacional del Cancer, Santiago, Chile
| | - Carolyn Mazariego
- Faculty of Medicine and Health, School of Population Health, UNSW Sydney, Randwick, New South Wales, Australia
| | - Csaba L Degi
- Faculty of Sociology and Social Work, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Manne
- Department of Medicine, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Luzia Travado
- Champalimaud Clinical and Research Center, Champalimaud Foundation, Lisbon, Portugal
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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