Global goal setting: a pathway to results 2.

5 x 2025
Washington, DC May 7th, 2013

Felicia Marie Knaul, PhD

Harvard Global Equity Initiative, Global Task Force on Expanded Access to Cancer Care and Control in LMICs Union for International Cancer Control Tmatelo a Pecho A.C. Mxico Mexican Health Foundation

Women and mothers in LMICs face many risks through the life cycle: The New Maternal Health Agenda
Women 15-59, annual deaths

- 35% in 30 years

Mortality in childbirth

Breast cancer

Cervical cancer

Diabetes

342,900

166,577

142,744

120,889

= 430, 210 deaths

Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.

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 disease-specific vertical programs or only on horizontal system constraints, harness synergies that provide opportunities to tackle disease-specific priorities while addressing systemic gaps.
Optimize available resources so that the whole is more than the sum of the parts. Bridge the divide as patients suffer diseases over a lifetime, most of it chronic.

Why diagonal delivery?

Shared risk factors Co-morbidity Life cycle approach Efficiency: Common need for strong health system platforms Knowledge sharing and inter-institutional collaboration Economic development Social justice

Diagonal Strategies: Positive Externalities

Promoting prevention and healthy lifestyles: Reduce risk for cancer and many other diseases Reducing stigma around womens cancers: Contributes to reducing gender discrimination Pain control and palliation Reducing barriers to access is essential for cancer as well as for for other diseases and for surgery.

Integrate cancer care and control into national insurance and social security programs to express previously suppressed demand beginning with cancers of women and children:

Country examples: Diagonalizing Financing:

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

Universal Health Coverage in Mexico through Seguro Popular

Expanded Benefit Package

Vertical Coverage Diseases and Interventions:

Horizontal Coverage:

> 54.6 million Beneficiaries

Seguro Popular:
Cancer and the Fund for Protection from Catastrophic Illness Accelerated, universal, vertical coverage by disease with an effective package of interventions 2004: HIV/AIDS 2005: cervical cancer 2006: ALL in children 2007: All pediatric cancers; Breast cancer 2011: Testicular and Prostate cancer and NHL 2012: Colorectal and ovarian cancer

Engaging breast cancer advocates:

REPORTE ROSA: MEXICO

Lessons 1: Advocacy + evidence + action

Non-governmental actors do unite around a common project with measurable goals and this enables engagement w/ government Evidence-Based Passion & Passion inspired Evidence
Advocacy without evidence is likely to be misguided and will tend towards error The mission of evidence is weakened when neither inspired by nor applied to the needs of patients and people

Methods for merging personal experience/advocacy and evidence have not been formally developed never been rigorously studied

Lessons 2: Diagonal Approach to Evidence-based, Passionate Advocacy

Advocating only for ourselves or our own disease, particular disease limits potential for impact: Huge responsibility for cancer, and especially breast cancer advocates The art of patient advocacy is going diagonal Common demands across diseases i.e. pain control Strengthen health and social systems Collaboration and cooperation strengthen your message Neglected and emerging areas for goal development: where patients do not live long enough to advocate for themselves Survivorship challenges long life with disease or symptoms quality of life Mental health - and the NCD movement

Lessons 3: Local and Global Inseparability: The opportunity-space?

Addressing disparities: not months but whole lifetimes to be gained Recognize disadvantaged groups as part of a global solution Focus on prevention but do not stop there
No prevent/treat dichotomization

Harness global and national health system platforms Innovate in implementation, delivery and financing

Why might a global, interinstitutional, goal-based initiative contribute:

Global evidence from childrens rights and MDGs MDGs post 2015 agenda NCD/UN agenda - UICC Global wake-up to new and emerging challenges to health in LMICs Knowledge base and treatment options for the disease Global accountability frameworks focussing on the health of women and children Frameworks for identifying priorities and measuring progress (GBD) Need for a Shared global vision that crosses divides: Patients, Providers, Global institutions

What might a global, interinstitutional, goal-based initiative contribute:

Shared vision and ownership ours; among ourselves
to enable us to contribute more effectively to global and national initiatives

lighthouse effect Better measurement of process and outcomes Generate more and better lives for women and their families and societies motor of and for broader goals of social development Promote uncharted areas for action - that can contribute to global and womens health Produce new knowledge that can help all women

Challenges and questions in designing a global, interinstitutional, goal-based initiative:

Funding gap Specific yet inclusive Vertical and horizontal Relevance/Excellence: measurement Interim goals that are
Achievable Instrumentally and intrinsically valuable to many Measurable Inspirational