WHO, the World Health Organisation, has released two very important initiatives: the cervical cancer elimination initiative and the global breast cancer initiative. The role, or the purpose, of that session was to tell civil society about the initiatives, mostly the global breast cancer initiative, to tell them or explain what are the pillars, what are the objectives, and then explain a little bit too how we’re going to implement, or how the WHO sees the implementation of these initiatives. For now, particularly GBCI is mostly a document, a very important document, a framework, but now we have to move that to implementation. Civil societies have to play a role, mostly because a lot of the organisations, they do advocacy, they work with their Ministers of Health, so really they’re going to play a role in pushing their governments to adopt some of the recommendations of these initiatives.
Also, there are a lot of organisations that provide services themselves. When you think about screening for breast cancer, patient navigation, education, all of that in this region and a lot of regions is provided by civil societies. Because they have to play that role, they also need to understand what’s in the framework, what are the best projects. If you want to implement the best buys, what are other organisations doing in the same region that maybe can be adopted or adapted. It is providing that context and that knowledge to the civil societies so they can be a real stakeholder in the implementation of these WHO initiatives.
What are some of the WHO global objectives?
The objectives of the global breast cancer initiative have three pillars. One is the health promotion for early detection, so it’s what they call the pre-diagnostic pillar. Then there is the diagnostic pillar, and then there is the treatment pillar. All these three buckets have their own KPIs. Then there are some activities or some examples of projects that can be implemented so countries can achieve that KPI. For example, you need education of the population if you want to be able to achieve early detection, but you also need the healthcare providers, for example the first responders, like low-level, the primary level, healthcare providers to also know about, to also be educated, be knowledgeable about the signs and symptoms of breast cancer. So that is an example: do not just do awareness for the population but include healthcare providers’ education and community education.
If you look at the diagnostic interval, it could be that the KPI is that should not last more than sixty days from the first symptoms or for the first time that somebody reaches out to the healthcare system until they have completed diagnostic. Not just, ‘Oh yeah, you’ve got a lump’, no, they have to have the triple assessment. You can achieve that by maybe incorporating some of the diagnostic centres in district hospitals, for example, in the middle level and not keep the diagnostic centres up at the tertiary level. There are all these things that the framework has a lot of really good information biut that now needs to be transformed into actionable projects, so little by little, everyone achieves the three KPIs.
What would be your message to global civil societies and governments?
The message to civil society is, you are a stakeholder as much as a policy maker or a hospital; you are a part of the solution, so do not give up, do not think that you are not a part of it. Don’t accept sometimes that secondary role that civil society is forced to play. Go with confidence and feel that you need to be included.
What I would say to governments and what I would say also to WHO as they’re thinking about the implementation, I would say the same: do not forget civil society, because they are the ones that are going to be implementing a lot of the projects, particularly in the first and second pillars.
We have tomorrow a workshop where we’re going to try to disentangle all of these things. We’re going to have breakout groups and we’re going to ask, what are the things that you can do to implement the framework? What are the things that you need? Do you need resources?” Everyone needs resources, money, but what are the other resources that you might need? You might need to travel to visit another project that you want to adapt. All these kind of things so that we can write a little bit of commentary, I would say, or some kind of a very short piece that says civil society needs this if we really want to be part of the implementation of the GBCI.
Could you provide some examples of other successful projects in the ASEAN region?
There are actually a couple of things. We’ve done a little bit of background research with the CBCS partners - these are countries or NGOs from countries that have hosted the symposium in other times. For example, in Indonesia there are two things: they have a project to improve the early detection of breast cancer, and this is using project ECHO. They’re training primary level healthcare providers in combination with hospitals, so it’s the NGO, the Indonesian Breast Cancer Society, working with a hospital, and then providing all that training for the Ministry of Health, or on behalf of the Ministry of Health. That is a very interesting project.
In the Philippines, in Manila, ICanServe, a Filippino NGO, they’re using the KPIs from the framework already to track their progress internally with their early detection programmes. So they’ve developed a very nice electronic system to collect the data that before they were just writing in notebooks; now it’s all electronic in iPads and they have a dashboard. The dashboard shows them in real time how much progress they are making to the sixty, sixty, eighty, KPIs of the initiative.
The WHO regional office has not engaged very actively in the development of the framework but what they’re doing is they’re connecting with their own national cancer institutes, and through the National Cancer Institute they’re writing a letter to the government, to the Ministry of Health, to tell them that they’ve been involved in the development of the framework and that they’d like to see these moving forward in many different ways. So there are a lot of best practices that could be learned between the countries, the CBCS countries.