Editorial series: cancer care in low- and middle-income countries

Abstract

Universal health coverage (UHC) is a central goal for healthcare systems worldwide. When evaluating progress towards the implementation of UHC in a given country, the World Health Organization (WHO) considers three dimensions of policy evaluation: the population groups within the country that are covered, the extent of financial protection for access to healthcare services, and the spectrum of services that are available. Although health policy agendas have helped to improve the quality of care in many low-and middle-income countries (LMICs), including the Eastern Mediterranean Region, sub-Saharan Africa and East Asia, progress to date in achieving UHC has not been optimal. Some of these countries with large populations, such as India and Indonesia, are currently implementing or rolling-out health insurance schemes that aim to cover the entire population in order to meet UHC criteria. However, adequate access to primary care as a key requirement of UHC is not universally achieved in many countries, particularly for vulnerable populations. Cancer care represents a major hurdle for UHC in LMICs, mainly due to lack of screening and early detection, poor education with regard to cancer, the cultural taboo of cancer, and the requirement for costly infrastructure for diagnosis and treatment, including educated personnel. This results in an unnecessarily high proportion of patients with metastatic and advanced tumor stages. In this editorial we outline how intentional and non-intentional consequences of policy decisions as well as the implementation of incentives during progress towards UHC can have a major impact on the quality and scope of cancer care in these countries.

Assessment of incentivizing effects for cancer care frameworks

“…Setting incentives is frequently associated with potential conflicts of interests (CoI) that can potentially harm patients. When CoI and other forms of decisional bias are sufficiently excluded or controlled, the intentional use of various types of incentives can promote beneficial cancer care development [ 1 ]. These incentives are not limited to physicians, and can impact on many stakeholders and professions, even including patients themselves, their relatives, as well as healthcare politicians.…”

Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries

“…This results in an unnecessarily high proportion of patients with metastatic and advanced tumor stages. 6 A study conducted in Cameroon pointed out the magnitude of the difficulties of accessing and receiving cancer care in semiurban areas where only patients 87.30% could pay for biopsy, 26.36% of those did not collect their results, 18.7% denied their results, and only 44 of 110 patients were able to finish their cancer care treatment program. 7 The problem of loss to follow-up (because of the cost of diagnosis and treatment to the patient) is another concern faced by LMICs.…”

Essential Elements in Improving Oncology in Low- and Middle-Income Countries (LMICs) and Examples for Their Implementation in Nigeria

“…The problem: Access to care is limited in LMICs. This is due to lack of enough cancer care facilities (Haier et al 2019). Radiation therapy is an important modality of cancer treatment, and it contributes to the cure or palliation.…”