Political priority and pathways to scale-up of childhood cancer care in five nations

被引:21
作者
Denburg, Avram E. [1 ,2 ,3 ]
Ramirez, Adriana [4 ]
Pavuluri, Suresh [4 ]
Mccann, Erin [4 ]
Shah, Shivani [2 ]
Alcasabas, Tricia [5 ]
Antillon, Federico [6 ,7 ]
Arora, Ramandeep [8 ]
Fuentes-Alabi, Soad [9 ]
Renner, Lorna [10 ]
Lam, Catherine [11 ]
Friedrich, Paola [11 ]
Maser, Brandon [2 ]
Force, Lisa [11 ]
Galindo, Carlos Rodriguez [11 ]
Atun, Rifat [4 ]
机构
[1] Hosp Sick Children, Div Haematol Oncol, Toronto, ON, Canada
[2] Hosp Sick Children, Child Hlth Evaluat Sci, Peter Gilgan Ctr Res & Learning, Toronto, ON, Canada
[3] Univ Toronto, Inst Hlth Policy Management & Evaluat, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[4] Harvard Univ, Harvard Sch Publ Hlth, Boston, MA 02115 USA
[5] Philippine Gen Hosp, Manila, Philippines
[6] Univ Franciso Marroquin, Sch Med, Guatemala City, Guatemala
[7] Unidad Nacl Oncol Pediat, Guatemala City, Guatemala
[8] Max Super Specialty Hosp, New Delhi, India
[9] Hosp Nacl Ninos Benjamin Bloom, San Salvador, El Salvador
[10] Korle Bu Teaching Hosp, Accra, Ghana
[11] St Jude Childrens Res Hosp, Dept Global Pediat Med, 332 N Lauderdale St, Memphis, TN 38105 USA
关键词
UNIVERSAL HEALTH COVERAGE; SUSTAINABLE DEVELOPMENT; PEDIATRIC ONCOLOGY; INCOME COUNTRIES; CENTRAL-AMERICA; GLOBAL HEALTH; GENERATION; CHILDREN; REGISTRIES; SURVIVAL;
D O I
10.1371/journal.pone.0221292
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Despite increasing global attention to non-communicable diseases (NCDs) and their incorporation into universal health coverage (UHC), the factors that determine whether and how NCDs are prioritized in national health agendas and integrated into health systems remain poorly understood. Childhood cancer is a leading non-communicable cause of death in children aged 0-14 years worldwide. We investigated the political, social, and economic factors that influence health system priority-setting on childhood cancer care in a range of low- and middle-income countries (LMIC). Methods and findings Based on in-depth qualitative case studies, we analyzed the determinants of priority-setting for childhood cancer care in El Salvador, Guatemala, Ghana, India, and the Philippines using a conceptual framework that considers four principal influences on political prioritization: political contexts, actor power, ideas, and issue characteristics. Data for the analysis derived from in-depth interviews (n = 68) with key informants involved in or impacted by childhood cancer policies and programs in participating countries, supplemented by published academic literature and available policy documents. Political priority for childhood cancer varies widely across the countries studied and is most influenced by political context and actor power dynamics. Ghana has placed relatively little national priority on childhood cancer, largely due to competing priorities and a lack of cohesion among stakeholders. In both El Salvador and Guatemala, actor power has played a central role in generating national priority for childhood cancer, where well-organized and -resourced civil society organizations have disrupted legacies of fragmented governance and financing to create priority for childhood cancer care. In India, the role of a uniquely empowered private actor was instrumental in creating political priority and establishing sustained channels of financing for childhood cancer care. In the Philippines, the childhood cancer community has capitalized on a window of opportunity to expand access and reduce disparities in childhood cancer care through the political prioritization of UHC and NCDs in current health system reforms. Conclusions The importance of key health system actors in determining the relative political priority for childhood cancer in the countries studied points to actor power as a critical enabler of prioritization in other LMIC. Responsiveness to political contexts-in particular, rhetorical and policy priority placed on NCDs and UHC-will be crucial to efforts to place childhood cancer firmly on national health agendas. National governments must be convinced of the potential for foundational health system strengthening through attention to childhood cancer care, and the presence and capability of networked actors primed to amplify public sector investments and catalyze change on the ground.
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相关论文
共 65 条
[1]   Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries [J].
Allemani, Claudia ;
Matsuda, Tomohiro ;
Di Carlo, Veronica ;
Harewood, Rhea ;
Matz, Melissa ;
Niksic, Maja ;
Bonaventure, Audrey ;
Valkov, Mikhail ;
Johnson, Christopher J. ;
Esteve, Jacques ;
Ogunbiyi, Olufemi J. ;
Azevedo e Silva, Gulnar ;
Chen, Wan-Qing ;
Eser, Sultan ;
Engholm, Gerda ;
Stiller, Charles A. ;
Monnereau, Alain ;
Woods, Ryan R. ;
Visser, Otto ;
Lim, Gek Hsiang ;
Aitken, Joanne ;
Weir, Hannah K. ;
Coleman, Michel P. .
LANCET, 2018, 391 (10125) :1023-1075
[2]  
[Anonymous], PLAN ESTR 2010 2014
[3]  
[Anonymous], CONSTR EQ UN COM SAL
[4]  
[Anonymous], GLOB IN CHILDH CANC
[5]  
[Anonymous], 2012, HLTH POLICY SYSTEMS
[6]  
[Anonymous], 2009, CASE STUDY RES DESIG, DOI DOI 10.1016/J.YMETH.2008.10.015
[7]  
[Anonymous], HLTH SECT MED DEV PL
[8]  
[Anonymous], 2005, Brokerage and closure: An introduction to social capital
[9]  
[Anonymous], LANCET
[10]  
[Anonymous], NAT CANC PLAN 2012 2