6
The need to build on recent progressCancer plans are being adopted and
are evolving, with signs of better
implementation. Most countries have
developed National Cancer Control Plans
(NCCPs), and they are often being updated
and refined. Still, existing best practices
in cancer planning could be adopted and
implementation levels are mixed across
countries. Countries like Peru (with the
2012 Plan Esperanza), Paraguay (with Law
6.266) and now Chile (with budget an
element being discussed in an ongoing
cancer law project) have gone beyond the
theoretical and produced legislation to
secure long-term institutional and financial
support. There are signs of increased citizen
mobilisation for cancer, but boosting patient
empowerment and influence on policymaking
should be a priority. Furthermore, effective
implementation of cancer plans will require
resources, strong governance and clear
leadership.
Strong registries underpin adequate
planning and policies, but there is much
progress to be made. The region combines
a long tradition of registries, with those in Cali
(Colombia) or São Paulo (Brazil) established
decades ago. Data from registries are crucial
for designing tailored policies and strategies
for cancer, as well as for monitoring progress.
There is evidence of progress, with Mexico,
for example, working on making up for its
historical lag in this area. Cancer research
more broadly is generally neglected, and
this complicates the creation of complete
epidemiological profiles and tailored, efficient
interventions as well as the adoption of
innovations and quality improvements.
A commitment to prevention is needed,
with the resources to back it up. Latin
America faces a multiplicity of risk factors
typical of developing economies and some
specific to the region. Successes in tobacco
regulation show determined action can
be achieved but promotion seems to lack
the drive that other cancer aspects have.
Public health systems have adopted good
practices of prevention, such as immunisation
campaigns against human papillomavirus
(HPV) and hepatitis B, as well as screening
for common types of cancer (including
breast, cervical and colorectal cancers).
However, there are great challenges in
adherence to interventions and in reaching
the entire population. This will require well-
planned approaches involving educational
programmes, an understanding of populations
and sustained funding.Although disparity exists, there are
generally gaps in service availability in
the public sector. There are important gaps
in most countries when it comes to oncology
equipment (such as linear accelerators
for radiotherapy) leading to waiting times
or lengthy transportation needed, which
affects treatment outcomes. This is seen
in both the poorer and richer countries of
the region. This is compounded by a lack of
oncology specialists, which is pervasive across
much of the region and affects suburban
and rural areas even more. Even though
UHC has enabled availability of medicines
(with morphine lagging behind), experts
interviewed for this report note delays and
difficulties in access due to administrative
hurdles in some of the countries. Experts also