WHO Global Initiative For Childhood Cancer And How The Caribbean . - PAHO

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Health System Strengthening for Childhood Cancer in the Caribbean 11 February 2020WHO Global Initiative for Childhood Cancer and how theCaribbean Subregion Fits InCatherine Lam, MD, MPH, FRCPC, FAAPDirector, Health Systems UnitDirector, Asia Pacific Regional ProgramAssociate Professor, Faculty Pediatric OncologistDepartments of Global Pediatric Medicine and OncologyCo-Director, WHO Collaborating Centre for Childhood Cancer

Background: WHO Global Initiative for Childhood CancerMay 2015September 2018WHA Side EventUNGA Launch215September 2011May 2017UNGA High-LevelMeeting on NCDsWHA Resolution34WHO announcedthe WHO GlobalInitiative forChildhood Cancerfollowing theHigh-LevelMeeting on NCDsAugust 2018Stakeholder Meeting at WHO

Mandate for Action from Member States

URGES Member States,1. To continue to implement the roadmap of national commitments (NCD) 2. To implement the four time-bound national commitments (NCD) 3. Tointegrateand scalenational cancerpreventionand controlcontrol (NCD) that are inclusive of all age Todevelopand upimplementnationalcancerplans4. To develop and implement national cancer control plans that are inclusive of all age groups groups 5. Tocollect high-quality population-based incidence and mortality data on cancer, for all age groups by cancertype To collect high-quality population-based incidence and mortality data on cancer, for6. all age groups by cancer 7. 8. 9. Toimplement,and monitorprogrammes for earlydiagnosisfor cancer management, inTodevelop,developand implementevidence-basedprotocols10. To develop and implement evidence-based protocols for cancer management, in children and adults, includingchildrencareand adults, including palliative care palliative11. To collaborate by strengthening regional and subregional partnerships Topromotecollaborateby strengtheningregionaland subregionalpartnerships12. Torecommendationsthat supportclinical decision-makingand referralbased on effective, safe -effective as well as training

WHOGlobal Initiative for Childhood CancerSetting a bold target for 2030By 2030,Double the cure rate, ensuring at least 60% survivalfor children with cancer globally, and reducing suffering for allSaving one million more children

Outputs &ActivitiesObjectivesGoalGlobal Initiative for Childhood CancerBy 2030, achieve at least a 60% survival rate for childhood cancer globally, and reducesuffering for all Save one million additional lives(i) increase capacity of countries to provide quality services for children with cancer, and(ii) increase prioritization of childhood cancer at the global, regional, and national levelsImplemented across 6-10 countries (by 2019-2020) and 18-25 countries (by 2021-2023)NationalRegionalGlobalCountry Assessments, CaseStudies, Support andImplementation PlansRegional Assessments andDialogues, Snapshots, andPolicy BriefsGlobal Framework, TechnicalPackage, Dashboard, andAdvocacy MaterialsApproach:Technical PackageCURE All Children with CancerCentres of Excellence andCare Networkswith sufficient competentworkforceAdvocacyUniversal Health CoverageRegimens for ManagementEvaluation and Monitoringwith benefit packages andorganizational models forquality serviceswith context-appropriateguidance, essentialtechnologies & medicineswith quality assurance andinformation systemsLeveraged FinancingLinked Policies/GovernanceSupporting Coherent Comprehensive Policies, Access and Coverage of Services, and Quality Health Systems

WHO Global Initiative for Childhood CancerTowards the Development of Global Technical GuidanceDr. André IlbawiTechnical Officer, Cancer ControlWorld Health OrganizationHeadquartersAdvocacyAriunzul GanbaatarEssentialmedicinesConsultant, Cancer ControlWorld Health OrganizationHeadquartersCostingDr. Catherine Lam &Dr. Scott HowardConsultants, Cancer ControlNursing

Global Initiative for Childhood Cancer: Index CancersAcuteLymphoblasticLeukemiaMost commonworldwideBurkittLymphomaCommon in manylow-incomecountriesHodgkinLymphomaCommon inadolescentsFrom addressing common challenges RetinoblastomaConnectingcommunities forearly icesLow-GradeGliomaConnectinghealth systems to connecting vital partners Highly curable, with proven therapies Prevalent in all countries Represents 50-60% of all childhood cancers (age 0-19) Helps to advance comprehensive childhood cancer services and systems strengthening

Global Initiative for Childhood Cancer: Focus CountriesEngagement of all countries and regions vitalAt least onefocus countrywill be initiallyidentified from each ofthe six WHO regionsduring Year 1-2 of theGlobal InitiativeA focuscountry isidentifiedas a sitethat is:Anticipated to demonstrate early measurable progress(including progress within the Global Initiative’s first twoyears); andSuitable to illustrate actions advancing one or morepillars of CURE All, while providing feedback for therefinement of tools as part of broader global initiative

WHO Global Initiative for Childhood Cancer: Initial Focus CountriesEngaging 200 working group experts from 90 organizationsWHO Workshops held in 2019: Myanmar Peru Philippines Uzbekistan GhanaWorkshops in planning for 2020: Zambia Morocco Ukraine (to be confirmed)Map courtesy of K. Marx & J. RitterUpdated: January 2020

From Framework to ActionUsing the CURE All framework or approach, 10 core projects have beenidentified as part of the WHO Global Initiative for Childhood Cancer, asstarting points from which local leaders can choose and prioritize nextsteps and resource needs (technical, financial and other)

CURE All Core ProjectsUzbekistan:Ranked Projects1Analysis of cancer health system32National Cancer Control strategy development / implementation23Implementation of cancer workforce training packages14National network and referral pathway strengthening75Defining national standards and guidelines for index cancers66Essential medicines and technologies strengthening, including via UN57Economic analysis and benefit packages review of cancer48Strengthening & linking cancer registries (population- & hospital-based)89Country dashboard for childhood cancer monitoring910Local/regional advocacy portfolios: case studies, awareness campaigns10

Next Steps to Achieve CURE All Goals for Children and Adolescents withCancer in UzbekistanOrganizingcomprehensive cancercare for childrenForming working groupswith pediatric hematologists& pediatric oncologistsDefining national needsfor cancer workforcetraining & unifyingsubspecialty of pediatrichematology/oncologywith nationalassociationPediatricbrain tumorPediatrichematologyGeneral & specialtypediatricsDrafting National Cancer Control Plan –engaging pediatric hematology & oncology& WHO/IARC/IAEA/St. Jude expertsPediatriconcologyMedical, surgical &radiation oncologyPrimary health care

WHO Toolkit to Support Implementation of CURE All Across Country Action PhasesPhases ofCountry ActionAreas of SupportAvailableSample Tools and ResourcesAssessmentTools Stakeholder map National and facility rapid assessment tool (cancer) Country profiles (cancer; childhood cancer)Plan, Cost& FinancePrioritizationand PolicyDialogues National workshop templates Tool to support priority setting, budgeting and health system planning Sample inputs for country-level investment case for childhood cancer Workforce planning toolImplementProgrammeImplementationSupport WHO guidance for management and supportive care for six indexchildhood cancers Programme on access to cancer medicines and technologies (diagnostics,AssessMonitor &ModifyProgrammeMonitoring &ImprovementSupportmedicines, devices) Sample strategies for workforce scale-up Core dataset for cancer registries and programme monitoring Framework for research priorities

Including devices and suppliesnecessary to diagnose andmanage cancers Including labs to help diagnose andguide management, encompassingtests to differentiate cancersubtypes and mutations thatdictate different treatment To enable safe and appropriate useof medicines

Making an Investment Case

EURO High-Level Meeting onNCDs Apr 2019: Turkmenistan: 44governmentsUN High-Level Meeting onUHC – New York Sep 2019Engaging with otherUnited Nationsagencies (UNDP,UNICEF)WHO Global Meeting onNoncommunicableDiseases and MentalHealth Dec 2019: OmanSEAR Regional Workshop onCancer Jun 2019

SEAR Regional Workshop onCancer Jun 2019Childhood Cancer in Key Message & Country Commitments

SEAR Regional Workshop onCancer Jun 2019Childhood Cancer in Key Message & Country Commitments Focus should include implementation of cost-effective primaryprevention strategies for cancer in adults, and cost-effectivestrategies to prevent treatment failure for cancer in children. Managing childhood cancers effectively as a core componentof comprehensive national cancer control programmes andin alignment with the interventions of the global initiativeshould be prioritized in order to decrease the number ofchildren lost to cancer. Countries need to develop clear national plans with timebound actions for childhood cancer control. National centresof excellence along with referral pathways for childhoodcancers should be developed to provide and improve cancerservices for childhood cancer.

UN High-Level Meeting onUHC – New York Sep 2019CURE AllWHO Global Initiative for Childhood Cancer

WHO Global MeetingOman Dec 2019WHO Non-communicable Diseases and Mental Health Global Meeting, Muscat, Oman Dec 2019https://www.bmj.com/NCD-solutions

Although many proven interventions for NCDs exist,many countries are lagging behind in implementingthem. The Commission identified the followingchallenges to implementation: Lack of political will, commitment, capacity, andaction Lack of policies and plans for NCDs. Difficulty in priority-setting. Impact of economic, commercial, and market factors. Insufficient (domestic and international) financing toscale up national NCD responses. Lack of accountability.

Background: St. Jude as first WHO Collaborating Centre for Childhood Cancer (2018)WHO Collaborating Centres are institutions designated by the WHO Director-General to carryout activities to strengthen institutional capacity and support implementation of the WHO’sprogrammesTerms of Reference 1:National Cancer Control Plans (NCCPs)Tools for prioritization, costing, and framework for monitoring & evaluationTerms of Reference 2:Platforms to Foster and Engage Leadership & Communities of PracticeTools for health system innovation diffusionTerms of Reference 3:In-Country Support and Workshops, with Global Stakeholder EngagementHighlight region- and country-sensitive needs for scaling up childhood cancercontrol

St. Jude National Cancer Control Plan (NCCP) Analytic Program(2014-Present)Cancer Plan In SJ Core Policy BankExistsOperationalNow, past orplannedReview of WHO CountryCapacity SurveysDetailed AnalysesSnapshot AnalysesSJCARES Systemshealthsystems@STJUDE.ORGPI: Catherine Lam

Sample Look at the Caribbean Subregion:Reported Existence of Cancer Plan?WHO Country Capacity SurveysCountry20102013201520172019Antigua andBarbudaNo dataNoNoNoNoBahamasNo dataNoNoNoNoBarbadosYesYesYesYesNot in effectBelizeNoNoYesYesYes, oNoDominican RepublicNoYesYesYesNoGrenadaNo dataNoNoNoNoGuyanaYesNo dataYesNoNo

Sample Look at the Caribbean Subregion:Reported Existence of Cancer Plan?WHO Country Capacity SurveysCountry20102013201520172019No dataNo dataNoNoNot in effectJamaicaNoNoYesYesNot in effectSaint Kitts and NevisNoNoYesNoNoSaint LuciaYesNoNoNoNoNo dataNo dataNoNoNoSurinameNoYesYesYesTrinidad and TobagoNoYesNoNoHaitiSaint Vincent and theGrenadinesYes, underdevelopmentYes, beingupdated

St. Jude Core Bank for Latin America & Caribbean:100 Plans Screened across 30 countries/areasSpanning 2005-2030 7000 text pageshealthsystems@STJUDE.ORG

Launched Feb 4 2020for World Cancer Day“At least 7 million lives could be saved over the nextdecade, by identifying the most appropriate sciencefor each country situation, by basing strong cancerresponses on universal health coverage, and bymobilizing different stakeholders to work together”, said DrTedros Adhanom Ghebreyesus, Director-General, WHO.

WHO Cancer Profiles 2020Have early detectionprogramme/guidelinesfor childhood cancer(2019)Have defined referralsystem for childrenwith cancer (2019)20% ofcountries33% ofcountries

WHO Cancer Profiles 2020

WHO Cancer Profiles 2020

Achieving the Global Initiative Targets in the Caribbean C: U: R: E: Enriched baseline and follow-up data, expanded to children 0-19 years A: L: L: Aligned integration of childhood cancer in national and regional policies Understanding and addressing bottlenecks to development and effectiveimplementation

Towards Care, Cure, and Health for All Avoidable deaths from childhood cancersin low- and middle-income countries resultfrom: lack of diagnosis, misdiagnosis ordelayeddiagnosis,obstaclestoaccessing care, abandonment oftreatment, death from toxicity, andhigher rates of detail/cancer-in-childrenLam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science 201935

WHO’s Triple Billion Targets by 2023

Thank You!Clam@stjude.org

Pediatric hematology Organizing comprehensive cancer care for children Pediatric oncology Pediatric brain tumor Forming working groups with pediatric hematologists & pediatric oncologists Drafting National Cancer Control Plan - engaging pediatric hematology & oncology & WHO/IARC/IAEA/St. Jude experts Defining national needs for cancer workforce

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