7
The need to build on recent progresscall for regular updates of public formularies
to incorporate the latest innovations. A more
co-ordinated and forward-looking approach
to medicine planning, purchasing and delivery
is required.
Driven by UHC commitments, there
are signs that investment in healthcare
is growing. The proportion of healthcare
spending out of total government spending
improved in eight of the 12 countries, while
out-of-pocket expenditure fell in all but
one country in the past ten years. This is
consistent with the introduction and scaling-
up of UHC programmes (Bolivia being the
latest adopter). However, optimal standards
for government spending needed to sustain
UHC commitments are still not met in all 12
countries. Health technology assessment
(HTA) agencies are consolidating in the region
and should be strengthened to play a larger
role in driving efficient interventions.
Principles of patient-centred care and
quality should feature higher on the
agenda. While patient organisations are
active in all of the countries, there is no
clear indication of their participation in
policymaking in five of the 12 countries
examined. However, there are signs of some
multidisciplinary collaboration in cancer
care (such as psychological support), with
most of the countries featuring policies in
this regard. But guidelines for long-term
follow-up, rehabilitation or return to work of
cancer survivors are missing in most of the
countries. Evidence-based guidelines for care
of common types of cancer are missing or
incomplete in more than half of the countries.Greater cross-sectoral co-ordination, co-
operation and integration will be needed
to drive change. There is a great deal of
healthcare system fragmentation in the
region. First, fragmentation in the institutional
set-up that drives policy implementation is
causing a slowdown in the implementation
of ambitious cancer plans. Second,
fragmentation in care delivery structures
creates inefficiencies and ultimately impacts
service quality and outcomes. Although there
is no magic formula to organise these complex
systems, experts interviewed for this study
call for more efforts to co-operate in order to
tackle the cancer challenge. Creating spaces
for citizenship participation, building bridges
with the private sector and collaborating
closely with cancer specialists are essential
and can bring new perspectives to address
this challenge.