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The need to build on recent progressGovernance and articulation: The
way forward
The final component of the ICP measured
intersectoral action and governance. This
is important, as the challenges of cancer
will demand resources and knowledge
from beyond the health sector. In Chile, Dr
Nervi points to the need to collaborate with
the private sector in closing the funding
gap ”through models of attractive fiscal
benefits”. And, as seen in previous chapters,
fragmentation is a big problem in Latin
America, from different perspectives. Multi-
sector dialogue may help lay the foundations
for further integration. Dr Ismael points out
that the lack of “intersectoral collaboration
among public, private and social-security
schemes has been an obstacle before.
Articulation is growing, and this will be the key
to sustainability of the system.”Intersectoral action was examined through
reviewing the existence of policies addressing
the social determinants of health (for example,
work, education and inequality). A number of
countries’ key policies have involved multipledisciplines for the overall improvement
of health-related outcomes. Examples of
this include Bolivia’s Strategic Plan of the
Ministry of Health 2016-20^108 or Costa Rica’s
Política Nacional de Salud 2015 (National
Policy on Health), promoting intersectoral
collaboration,^109 as well as Ecuador’s
“Strategy for inclusive health services” that
was developed by health authorities in
collaboration with human rights, gender and
inclusion authorities.^110Governance was measured through the proxy
of “control of corruption”, based on data
from the World Bank. Although a fairly broad
indicator, it provides a glimpse into the overall
efficiency and effectiveness of the public
sector. Corruption has also been noted for its
significant effects not only in budgets but also
on healthcare outcomes.^111 Except for Uruguay,
Chile and Costa Rica, countries analysed
fare poorly in this indicator in global terms.
This signals the need for equipping cancer
programmes with strong governance systems,
supported by strong institutions and with
citizens’ oversight.(^108) Ministerio de Salud, “Plan Estratégico Institucional 2016-2020”, 2017.
(^109) Ministerio de Salud, “Política Nacional de Salud ‘Juan Guillermo Ortiz Guier’”, 2015.
(^110) Ministerio de Salud Pública, “Implementación de la estrategia de servicios de salud inclusivos en los establecimientos de salud de primer nivel de
atención del Ministerio de Salud Pública - Instructivo”, 2018.
(^111) National Academies of Sciences, Engineering, and Medicine, “Crossing the global quality chasm: Improving health care worldwide”, 2018.