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21

The need to build on recent progress

Notwithstanding the advances in the

development of new policies, the ICP finds

that the comprehensiveness of cancer plans

varies. In our examination, Costa Rica (Plan

Nacional para la Prevención y Control del

Cancer 2011-17) and Peru (Plan Esperanza)

are the most complete documents, with key

attributes such as:

• defining specific objectives and targets,
  including actions addressing the full cancer
  care continuum (prevention, early detection
  and diagnosis, treatment, as well as palliative
  care);


• incorporating patient-centred approaches;


• assigning clear responsibilities and
  resources;


• describing a detailed timeline; and


• addressing monitoring and evaluation.
  While effective implementation of the cancer
  plan will rely on multiple factors—especially
  having a budget—having clearly specified
  plans can certainly facilitate co-ordination and
  action.

Even with adequate plans, however, the

institutional and administrative limitations

of the system can make operationalisation

challenging. In Ecuador, Jose Ruales, former

under-secretary of health promotion at the

Ministry of Health, believes that “governance

is not clear or strong enough to guide or

implement the national strategy”, and he

also mentions the lack of a network of health

authorities and a leading entity. A similar

situation is evident in Colombia, where

Dr Murillo notes “a lack of a shared vision

between participating agencies”. He refers, for

example, to the need for better co-ordination

in the work of the Ministry of Health, Instituto

Nacional de Cancerología, the Cuenta de Alto

Costo (a fund for the management of high-

cost diseases), the Instituto de Evaluación

Tecnológica en Salud (Colombia’s HTA agency)

and the Instituto Nacional de Salud in the use

of unified cancer data.

(^39) Consejo Nacional Electoral. “Iniciativa Popular de Proyecto de Ley de Lucha contra el Cáncer cumplió firmas requeridas”, 2018.

Often overlooked is the crucial role

of citizenship in policymaking.

Often overlooked is the crucial role

of citizenship in policymaking: in our

examination, about half of the countries did

not show evidence of patients associations

participating in policymaking. Ecuador has

an interesting case in the Iniciativa Popular

Normativa, a political mechanism for the

development of citizen-led legislative

projects, which has recently been used to

propose a law supporting the fight against

cancer.^39 The effort has been endorsed by

more than 100,000 citizens and has taken

three years of work. As Mr Merino points out:

“Citizens should be empowered to participate

in policymaking, guaranteeing that their

needs are reflected and their inputs are

considered.” Chile has also recently developed

an innovative online platform for citizenship

participation in the design of its proposed

cancer law (see box on page 27).

Lack of financial resources is also a crucial

limitation, as often plans make relatively

vague mentions of budgets. In some of the

countries analysed, funding has been secured