The COVID-19 pandemic underscored the unique position of cities to rapidly respond to the world’s most urgent crises. But it also showed that the value of cities in combating non-communicable diseases (NCDs) extends well beyond simple service delivery.

With over half of the world’s population living in urban environments—a number that’s expected to grow to nearly 70% within three decades—there is growing recognition of the central role that cities play in leading social change, creating economic opportunities and strengthening community health. Cities are essential to achieving the UN sustainable development goals by the 2030 deadline.

Thinking globally, acting locally

The partnership between Access Accelerated and City Cancer Challenge (C/Can) is helping to realize the potential of local action to achieve better access to quality cancer care. C/Can is an initiative designed to support cities in low- and middle-income countries as they work to improve their populations’ access to diagnosis, treatment and care. As a foundational partner, Access Accelerate provided critical seed funding for C/Can’s launch in 2017.

“Our partnership with C/Can has been a very important part of our strategy to support cities to develop locally led solutions that effectively address NCDs,” says Ryojun Take, Senior Director, External Affairs Department of Chugai Pharmaceuticals and member of the Access Accelerated Steering Committee. “The strength of the partnership has allowed us to move quickly and help C/Can realize the results that they are now seeing in their cities, from positive policy change to securing sustainable financing.”

Today, C/Can cities have a tested model that is scalable and can be adapted to different contexts, in other cities in the country, and around the world. In Asunción, one of the thirteen C/Can cities, the City Executive Committee of the Paraguayan capital played an instrumental role in positioning cancer as a political priority at the national level. This meant passing the country’s first comprehensive cancer law, with allocated funds enabling important changes to the National Cancer Control Program in the National Cancer Institute.

“Within five years, stakeholders in the city of Asuncion have worked with C/Can to bring cancer to the top of the national health agenda” says Isabel Mestres, CEO of C/Can. “Thanks to these efforts, the Paraguayan Ministry of Public Health has made it mandatory for all hospitals and institutions providing cancer care to set up multidisciplinary tumor committees to evaluate cancer cases, while breast cancer guidelines developed by the city are being adopted nationwide.”

Unlocking sustainable financing solutions 

Another core pillar of C/Can’s work is addressing health financing, supporting city stakeholders with better resource mobilization and allocation for cancer care and coverage of patient costs. C/Can’s integrated and multisectoral approach means that it is in a unique position to act as a last mile implementor of health financing initiatives. It leverages existing engagement across city institutions to collect real-world data that’s developed into local investment cases.

“It’s critical that we ensure the financial sustainability of cancer care delivery,” explains Mathieu Morand, Senior Manager, Digital Health and Financing for C/Can. “Supporting decision makers in addressing local health financing challenges is necessary to ensure that cities are able to continue to build on the progress being made and create change that can last beyond the life of the C/Can city projects.”

This work is being supported by financing institutions, such as the International Finance Corporation (IFC) from the World Bank Group, on feasibility studies for infrastructure Public-private Partnerships (PPPs), while C/Can brings their technical expertise to the cities to complement locally-evidenced recommendations.

Dialogue on sustainable financing is also being supported by the cities themselves. In November 2021, C/Can hosted a dedicated stakeholder workshop in Leon Mexico, to raise awareness on the challenges and solutions in the existing local financing ecosystem that the C/Can initiative could accelerate.

Flexible funding creates more agile initiatives

The flexibility that is possible with Access Accelerated funding means that partners like C/Can can be more adaptable and agile in responding to stakeholder needs.

“No two C/Can cities are identical,” says Isabel. “An important part of our process is a needs assessment, a data collection which identifies the major cancer care needs and actions to close the gaps in care. The model requires local contextualization, but is also scalable. Through funding and support from Access Accelerated and our partners, C/Can is able to better respond to a city’s specific needs, which leads to solutions that are adopted and embedded locally.”

Digital health innovations, policies and processes are examples of areas in which cities across C/Can’s network have identified a growing need for support and investment. In Kumasi, Ghana, for example, stakeholders are leveraging the power of health technologies to address the fragmentation of its health information sources. This year, a lab networking solution to connect pathology laboratories across the city is being developed to facilitate the exchange of diagnostic data between the 15 public and private city labs. Connecting the city’s labs will help to strengthen collaboration, enhance efficiencies in diagnostic services and ultimately improve patient outcomes.

Thinking bigger

With the help of Access Accelerated and other strategic partners, C/Can has expanded from supporting four cities in 2017 to 13 in 2022, reaching over 59 million people, supporting more than 2,000 healthcare professionals and developed over 70 solutions to improve access to quality cancer care. Cities around the world, from Cali, Colombia to Nairobi, Kenya, have benefited from the initiative’s reach.

“Partnerships such as this strengthen localized efforts, but we can see the impacts nationally and regionally,” says Ryojun. “Most importantly, it delivers real results for patients and their families.”