Political priority and pathways to scale-up of childhood cancer care in five nations

Abstract

Background Despite increasing global attention to non-communicable diseases (NCDs) and their incorporation into universal health coverage (UHC), the factors that determine whether and how NCDs are prioritized in national health agendas and integrated into health systems remain poorly understood. Childhood cancer is a leading non-communicable cause of death in children aged 0–14 years worldwide. We investigated the political, social, and economic factors that influence health system priority-setting on childhood cancer care in a range of low- and middle-income countries (LMIC). Methods and findings Based on in-depth qualitative case studies, we analyzed the determinants of priority-setting for childhood cancer care in El Salvador, Guatemala, Ghana, India, and the Philippines using a conceptual framework that considers four principal influences on political prioritization: political contexts, actor power, ideas, and issue characteristics. Data for the analysis derived from in-depth interviews ( n = 68) with key informants involved in or impacted by childhood cancer policies and programs in participating countries, supplemented by published academic literature and available policy documents. Political priority for childhood cancer varies widely across the countries studied and is most influenced by political context and actor power dynamics. Ghana has placed relatively little national priority on childhood cancer, largely due to competing priorities and a lack of cohesion among stakeholders. In both El Salvador and Guatemala, actor power has played a central role in generating national priority for childhood cancer, where well-organized and -resourced civil society organizations have disrupted legacies of fragmented governance and financing to create priority for childhood cancer care. In India, the role of a uniquely empowered private actor was instrumental in creating political priority and establishing sustained channels of financing for childhood cancer care. In the Philippines, the childhood cancer community has capitalized on a window of opportunity to expand access and reduce disparities in childhood cancer care through the political prioritization of UHC and NCDs in current health system reforms. Conclusions The importance of key health system actors in determining the relative political priority for childhood cancer in the countries studied points to actor power as a critical enabler of prioritization in other LMIC. Responsiveness to political contexts–in particular, rhetorical and policy priority placed on NCDs and UHC–will be crucial to efforts to place childhood cancer firmly on national health agendas. National governments must be convinced of the potential for foundational health system strengthening through attention to childhood cancer care, and the presence and capability of networked actors primed to amplify public sector investments and catalyze change on the ground.

Sustainable care for children with cancer: a Lancet Oncology Commission

“…The methodology is presented in detail elsewhere and summarised in appendix panel 4 (pp. 21-22) 71,72 In each of the five countries studied, philanthropic organizations, foundations or private institutions had been the first to establish services for childhood cancer, often working with international partners (panel 4). Childhood cancer had not been a priority in the publicly funded health systems of these countries due to political instability and competing policy priorities.…”

The cost‐effectiveness of treating childhood cancer in 4 centers across sub‐Saharan Africa

“…A recent systematic review demonstrated that although the few studies conducted to date uniformly concluded that childhood cancer treatment in LMICs is cost‐effective, many did not comprehensively capture all the associated costs of treatment 6 . In addition, to our knowledge, very few rigorous studies were conducted in sub‐Saharan Africa, which will account for nearly one‐half of the total global childhood cancer burden by 2030 and where health systems routinely face acute resource constraints, resulting in difficult decisions concerning how best to allocate scarce public funds 1,7,8 . Previous work by our team demonstrated that operating a childhood cancer treatment center in Accra, Ghana, is very cost‐effective by international standards 9 .…”

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

“…These efforts, including partnerships with paediatric cancer centres in HICs, promote capacity building, education of healthcare personnel, implementation of treatment strategies, and establishment of research programmes adapted to local capacity and needs 11. However, recognition of the limits of such initiatives in terms of health system integration and sustainability has prompted increasing emphasis on the importance of national childhood cancer strategies, and evidence to support governmental priority-setting accordingly 14…”