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Paraguay: Public Private Partnership fosters new cancer policy to save lives

Cancer mortality rates in children show unacceptable inequalities between high and low- and middle-income countries. In the latter, late diagnosis, inadequate access to healthcare facilities, and treatment abandonment are the main hurdles for remission. For over 12 years, My Child Matters program has funded 58 cancer projects in more than 40 low- and middle-income countries, reaching so far over 85,000 children. The goal of this initiative, developed by the Fondation Sanofi Espoir, aims to bring equity so that all children with cancer will have the same chance to heal wherever they are in the world.

My Child Matters is supporting Pr Samudio’s oncopediatric team in Asunción, Paraguay, since 2009[1]. The first objective agreed with the Asunción hospital was to decentralize the cancer care offer in creating clinics in remote areas, and therefore to allow early diagnosis and avoid treatment interruptions of acute lymphoblastic leukaemia due to geographical constraints. These first goals were reached since, as of today, the number of patients in satellite clinics took off (from 81 in 2009 to 884 patients in 2015)[2], and 0% of children are stopping their treatment compared to the baseline rate (17.5%) in 2009. Impactful measures explain these positive outcomes: clinicians reinforced their key educational messages about adherence to therapy, timely diagnosed and managed side-effects of treatments close to patients’ homes. Besides that, the programme connected the different public health institutions involved in paediatric cancer system in Paraguay, encouraging a cooperative and complementary network. For example, electronic patients’ registration and follow-up systems, as well as national cancer registry, pave the way to the continuity of care.

In order to extend the progress made in quality cancer care from children to adults, and to rethink the Paraguayan health system in this therapeutic area, Asunción City was included into the City Cancer Challenge initiative in May 2017. The program accelerated discussions between private and public sectors gathered around a dedicated City Executive Committee. The main outcome of these high-level discussions was pointed out: the high fragmentation of the national healthcare system hampered quality and effective care for patients with cancer. This analysis was the starting point of an ambitious workstream aiming to legally reshape the landscape of cancer services in the country, in order to create a system where equity, collaboration and cost-effectiveness were central. A Cancer Law resulted from this process.

In October 2018, the Senate of Paraguay has voted the proposed Cancer Law finally promulgated on January 3rd, 2019. This Law frames an integrated approach for quality cancer services, next to the establishment of a multisectoral National Cancer Advisory Board including the Ministry of Health, the National Council for Research and Technologies, public and private hospitals, the City Cancer Challenge Executive Committee, and Pharmaceutical companies. This huge step towards the quality care in oncology would not have been possible without the impetus of both My Child Matters’ and C/CAN teams. The concrete achievement should be associated with this flagship initiative where efforts were joined to improve patients’ outcomes. It clearly highlights the tremendous value brought by multi-stakeholders collaboration to foster health improvement.

[1] Pr Angelica Samudio is responsible of the Oncopediatric Department into Las Clinicas in Asunción hospital.

[2] Howard et al., The My Child Matters Programme : effect of public-private partnerships on paediatric cancer care in low-income and middle-income countris. Lancet Oncol 2018; 19:e252-66.


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