Innovations in Financing and Delivery of Cancer Care in Mexico: implementing a diagonal approach

June 3, 2013
American Society of Clinical Oncology Annual Meeting
Chicago, IL.

Felicia Marie Knaul, PhD

Harvard Global Equity Initiative, GTF.CCC Tmatelo a Pecho and Mexican Health Foundation UICC Board Member 2012-14

Disclosure of Conflict of Interest

Through the GTF.CCC and Funsalud, I receive grant support from GSK, Sanofi, NADRO, Chinoin, and Pfizer Inc for research on global cancer care and control and health financing. I will not discuss products of these companies. I live with breast cancer, diganosed and treating primarily in Mexico. Felicia Marie Knaul

Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries

= global health + cancer care

Closing the Cancer Divide:

A BLUEPRINT TO EXPAND ACCESS IN LMICs

Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health

The Diagonal Approach to Health System Strengthening

Rather than focusing on either disease-specific vertical or horizontal-systemic programs, harness synergies that provide opportunities to tackle diseasespecific priorities while addressing systemic gaps and optimize available resources Diagonal strategies: X = > parts
Bridge disease divides: patients suffer over a lifetime, most of it chronic. Generate positive externalities

Mexicos 2003 Health reform created Seguro Popular

Affiliation:
Vertical Coverage Diseases and Interventions:

Benefit package:
2004: 113 2012: 284+57

Benefit Package Horizontal Coverage:

2004: 6.5 m 2012: 54.6 m

Beneficiaries

Mxico: Seguro Popular and Cancer

Diagonalizing Financing:
Integrate cancer care and control into national insurance and social security programs beginning with cancers of women and children:

Mexico, Colombia, Dom Rep, Peru China, India, Thailand Rwanda, Ghana, South Africa

Financing cancer in Seguro Popular:

Fund for Protection from Catastrophic Illness
Accelerated, universal, coverage by disease including a broad package of effective interventions 2005: Cervical cancer 2006: ALL in children 2007: Breast cancer, pediatric cancers 2011: Testicular, Prostate, NHL 2012: Ovarian, colorectal

Evidence of impact: adherence to treatment Childhood cancers:

70% to 95%

Breast cancer, INCAN:

2005: 200/600 2010: 10/900

Abish: care financed by Seguro Popular

Effective financial coverage of breast cancer in Mexico

Primary prevention Secondary prevention (early detection) Diagnosis Treatment Survivorship care Palliative care

Large and exemplary investment in cancer treatment for women, yet a low survival rate. Opportunities to diagonalize delivery

Breast Cancer: Delivery failure

# 2 killer of women 30-54 5-10% detected in Stage 0-1 Poor municipalites: 50% Stage 4; 5x the rate for rich

% diagnosed in Stage 4 by state

RIch

Poor

Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities

Solution: Diagonalizing Delivery

Harness platforms by integrating breast and cervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/AIDS, social welfare and anti-poverty programs.

Diagonalizing Delivery: Including breast cancer awareness for early detection in Oportunidades
Gua de orientacin y capacitacin a titulares beneficiarios del programa Oportunidades includes information on breast cancer as of 2009/10 1.5 million copies to promoters Reaches 5.8 million families = more than 90% of poor households

Diagonalizing Delivery: Training primary care providers in early detection of breast cancer
Health promoters (3650), Nurses & doctors (1400), medical students (550)
Nuevo Leon, Jalisco, Morelos ++

Significant increase in knowledge, especially in CBE

Ongoing challenges and Opportunities for evidencebased advocacy and action

Survivorship care including reducing stigma
Qualitative study in Mexico and Brazil, linked to India and Tanzania

Access to pain control and palliation

Training program Mexico and Uganda w/ GAPRI and FHCRC