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The need to build on recent progress

Chapter 4: Health systems and governance

Political commitment through

spending

The ICP measures political will through a

combination of indicators measuring financial

commitments and institutional developments.

Not all the aspects considered in this domain

are cancer-specific, and this acknowledges that

cancer cannot be defeated by cancer-focused

activities alone. A robust health ecosystem will

be required.

In terms of government spending on health,

Chile comes out on top in the ICP. The

index measures ten-year growth in general

government expenditure on health as a

percentage of total government expenditure.

This is a composite score based on the ten-

year average of—and average annual growth

Key takeaways

• There is important progress in healthcare-sector investment in the region. However,
  optimal standards for government spending and out-of-pocket spending are still not
  met in all countries. Health technology assessment agencies are consolidating and
  should play a larger role in driving efficiency of cancer interventions.


• Infrastructure gaps are a concern across the region. Strategies for scaling up services
  that face budget limitations should be considered. These may include training
  of support professionals (such as nurse practitioners), strengthening of primary
  healthcare networks, and also building alliances with the private sector and civil
  society.


• There are emerging discussions on intersectoral collaboration for care delivery
  and also for funding of cancer services. These can be the foundations for stronger
  governance in cancer programmes.

rate in—government expenditure on health

as a share of government expenditure. Peru

also does well on this indicator, while Bolivia,

Ecuador and Brazil are the laggards.

Looking at the underlying spending data, the

indicator “general government expenditure in

health over total government expenditure”,

based on WHO data, measures overall

prioritisation of health in the political agenda

over the past ten years. This proportion has

improved in most countries (eight out of 12).

The country with the highest average growth

in this indicator is Peru, averaging a 10.2%

increase each year, and rising from 7.3% in

2007 to 16.2% in 2016. This is a remarkable

improvement and it’s consistent with the rise

in insurance coverage of the population from

53% in 2008^82 to about 80% in 2016.^83

(^82) K Strasser-Weippl et al., “Progress and remaining challenges for cancer control in Latin America and the Caribbean”, The Lancet Oncology, 2015.
(^83) Aníbal Velásquez, “Salud en el Perú: hacia la cobertura universal y una respuesta efectiva frente a riesgos sanitarios”, Revista Peruana de Medicina
Experimental y Salud Pública, 2016.