Susan G. Komen is helping to eliminate disparities in treatment and outcomes by empowering low-income populations; facilitating access to breast cancer training for health professionals from the public health system; and improving health systems by strengthening evidence-based projects that are sustainable and induce changes in care systems. In Brazil, since 2007, Komen’s work has led to direct engagement with the public and private sector to raise awareness of the disease and address geographic and socio-economic inequities in service delivery and access. Today, breast cancer is the most significant cause of cancer mortality and morbidity among women in Brazil. The public health system, called the Unified Health System, or Sistema Único de Saúde (SUS), is administered at the federal, state and municipal levels. The point of entry for clients is primary health care “basic health units” (unidade básica de saúde or UBS) which are responsible for breast health education, clinical breast examination, promotion of mammography screening and referral. Secondary and tertiary care for breast cancer (diagnostics and treatment) is provided at public and private sector facilities, financed through both public and private mechanisms.
Analyses of the organization of breast health service delivery commissioned by Komen in Sao Paulo and Salvador revealed a lack of coordination of care, resulting in delays at every level of the continuum of care, due to the high demand and fragmentation of services. Facilities that provide a range of services (e.g. education, screening, diagnosis, treatment and follow-up care) in one place are very limited. A large portion of the services are concentrated in urban areas of several cities and wealthier areas are far better covered than socially deprived areas, despite high population densities. Komen’s strategy in the state of Sergipe, in Brazil’s Northeast Region, is to integrate breast cancer patient support, early detection, and timely/quality diagnosis into existing health care services in Aracaju, Sergipe and surrounding cities, to facilitate the progression of women through the different phases of the continuum of care. This program is serving as a demonstration project for improving breast cancer control.
- To map existing resources including human resource availability, service distribution mechanisms and breast cancer service capacity.
- To reduce time between screening; diagnosis and start of treatment using the One stop clinic approach that has proven to be effective in the State of Sao Paulo.
- To improve quality of screening exams by training health providers to be able to perform mammography with higher diagnostic quality.
- To provide patient support navigating the system and understanding patient rights; including access to a helpline and the development of an educational toolkit for patient support.
With funding from the Pfizer Foundation*, Komen is working with local implementing partners, the Secretary of Health for the Aracaju Municipality, and the Secretary of Health for the State of Sergipe to address these specific gaps in breast cancer control while leveraging existing community resources. Additionally, representatives from key institutions in Brazil have been appointed to a project advisory committee (PAC) to offer support, critique, and guidance on the implementation of the program.
* The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions
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