Table 6Examples of actions to bridge identified gaps in cancer control in a low-resource country

Health situationLevel of interventionsKey actions in a selected geographical area served by the regional cancer centreWho has the power to decide on key actions?How could they be activated to decide?
GAPS
(difference between OBSERVED and DESIRED status)

OBSERVED STATUS
High mortality from breast and cervical cancer

Over 80% of breast and cervical cancer patients are diagnosed in very late stages

Less than 20% of children with acute lymphatic leukaemia have access to full treatment and over 80% die within 5 years

DESIRED STATUS
Reduction in breast and cervical cancer mortality

Not more than 20% of breast and cervical cancer cases diagnosed in late stages

Over 70% of children with acute lymphatic leukaemia have access to full treatment and over 60% survive for 5 years


STRENGTHS
Existence of specialized diagnostic and treatment facilities, strong primary health care network and community health initiatives in some geographical areas

Health insurance system under development

A ward for treating children with acute lymphatic leukaemia recently inaugurated
CORE
With existing resourcesFor the selected cancer types, elaborate and disseminate standards for early diagnosis, referral, follow-up and clinical management, including psychosocial support, pain relief and palliative care

Identify the specific target groups, estimate the demand for services, and reorient referral mechanisms and diagnostic, treatment and palliative care services to ensure timeliness and quality of actions

Include palliative care medication, as well as the chemotherapy drugs and antibiotics used for treating paediatric acute lymphatic leukaemia, in the national essential medicines list

Establish outpatient clinics for ambulatory treatment and follow-up

Include early detection, diagnostic, treatment and palliative care packages in the health insurance scheme

Ensure full coverage of diagnosis and treatment for patients from underprivileged communities

Train health-care professionals at all levels of care and introduce adequate referral mechanisms

Train family caregivers and promote the formation of parents/patients support groups

Create a basic information system to monitor and evaluate related activities at different levels of care
The local health authorities together with the leading health-care professionals of relevant sectors, supported by the national authoritiesBy providing relevant information on the problem and its possible solutions through personal interactions and meetings with the relevant stakeholders, using the testimonies of patients and health-care providers
EXPANDED
With a projected increase in, or reallocation of, resourcesIdentify partners in the community and develop joint educational strategies for early detection of breast and cervical cancers aimed at the target women

Adjust the primary health-care services and the specialized clinical services to meet the estimated increase in demand for breast and cervical cancer care

Correct weaknesses identifed through the monitoring and evaluation system

Improve quality and coverage of diagnostic, treatment and palliative care services for acute lymphatic leukaemia in children, and mobilize further social support for patients and their families
Local authorities from political, health and educational sectors, supported by the national authorities

Health-care and community leaders, traditional healers
By disseminating the results of the evaluation of previous (core) activities

By advocating to reach more women in the target age group attached to community organizations
DESIRABLE
When more resources become availableDevelop educational strategies and low-cost media campaigns for early detection of breast and cervical cancer aimed at all women

Develop special strategies for increasing the adherence to treatment of children with acute lymphatic leukaemia

Monitor the activities and evaluate the results

If the evaluation in the target areas is satisfactory, start mobilizing resources to expand activities to the rest of the country using a similar stepwise approach
National and local leaders in the political, health and educational sectors

Health-care and community leaders

Leaders of national and local associations
By disseminating the results of the evaluation of previous (core and expanded) activities

By advocating to reach all women in the target age group in the whole selected community via community outreach

By advocating to expand activities to the rest of the country

From: PLANNING STEP 3: How do we get there?

Cover of Cancer Control: Knowledge Into Action
Cancer Control: Knowledge Into Action: WHO Guide for Effective Programmes: Module 4: Diagnosis and Treatment.
Copyright © World Health Organization 2008.

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