Achieving flexible competence: bridging the investment dichotomy between infectious diseases and cancer

Abstract

Today’s global health challenges in underserved communities include the growing burden of cancer and other non-communicable diseases (NCDs); infectious diseases (IDs) with epidemic and pandemic potential such as COVID-19; and health effects from catastrophic ‘all hazards’ disasters including natural, industrial or terrorist incidents. Healthcare disparities in low-income and middle-income countries and in some rural areas in developed countries make it a challenge to mitigate these health, socioeconomic and political consequences on our globalised society. As with IDs, cancer requires rapid intervention and its effective medical management and prevention encompasses the other major NCDs. Furthermore, the technology and clinical capability for cancer care enables management of NCDs and IDs. Global health initiatives that call for action to address IDs and cancer often focus on each problem separately, or consider cancer care only a downstream investment to primary care, missing opportunities to leverage investments that could support broader capacity-building. From our experience in health disparities, disaster preparedness, government policy and healthcare systems we have initiated an approach we call flex-competence which emphasises a systems approach from the outset of program building that integrates investment among IDs, cancer, NCDs and disaster preparedness to improve overall healthcare for the local community. This approach builds on trusted partnerships, multi-level strategies and a healthcare infrastructure providing surge capacities to more rapidly respond to and manage a wide range of changing public health threats.

Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts

“…In addition to its prompt adaptation in responding to the pandemic, the PHC depends on the continuity of care for users with chronic noncommunicable diseases (NCD) to ensure their great performance. Keeping users with chronic conditions at the center of care, considering their vulnerabilities to acute and infectious diseases, requires adjustments in in-person health care strategies, which also benefit from remote health care 17 . The guarantee of access to different levels of health care refers to the comprehensiveness of the system and presupposes defined and organized flows and a corresponding scale between health care units, territory, and the population 18 .…”