Global goal setting: a pathway to results 2.5 x 2025

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Washington, DC., 7 de mayo de 2013

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Global goal setting: a pathway to results 2.5 x 2025

  1. 1. Felicia Marie Knaul, PhD Harvard Global Equity Initiative, Global Task Force on Expanded Access to Cancer Care and Control in LMICs Union for International Cancer Control Tómatelo a Pecho A.C. México Mexican Health Foundation Washington,  DC   May  7th,  2013   Global  goal  se9ng:     a  pathway  to  results   2.5  x  2025  
  2. 2. Women and mothers in LMICs face many risks through the life cycle: The New Maternal Health Agenda Diabetes 120,889 Breast cancer 166,577 Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011. Cervical cancer 142,744 Mortality in childbirth 342,900 - 35% in 30 years = 430, 210 deaths Women 15-59, annual deaths  
  3. 3. The Diagonal Approach to Health System Strengthening !   Rather than focusing on disease-specific vertical programs or only on horizontal system constraints, harness synergies that provide opportunities to tackle disease-specific priorities while addressing systemic gaps. !   Optimize available resources so that the whole is more than the sum of the parts. !   Bridge the divide as patients suffer diseases over a lifetime, most of it chronic.
  4. 4. Why diagonal delivery? !  Shared risk factors !  Co-morbidity !  Life cycle approach !  Efficiency: Common need for strong health system platforms !  Knowledge sharing and inter-institutional collaboration !  Economic development !  Social justice
  5. 5. Diagonal Strategies: Positive Externalities !   Promoting prevention and healthy lifestyles: !   Reduce risk for cancer and many other diseases !   Reducing stigma around women’s cancers: !   Contributes to reducing gender discrimination !   Pain control and palliation !   Reducing barriers to access is essential for cancer as well as for for other diseases and for surgery.
  6. 6. Country examples: ‘Diagonalizing’ Financing: Integrate cancer care and control into national insurance and social security programs to express previously suppressed demand beginning with cancers of women and children: !  Mexico, Colombia, Dom Rep, Peru !  China, India, Thailand !  Rwanda, Ghana, South Africa
  7. 7. Universal Health Coverage in Mexico through Seguro Popular Horizontal  Coverage:     >  54.6  million  Beneficiaries   Ver1cal  Coverage       Diseases  and  Interven1ons:      Expanded  Benefit  Package      
  8. 8. Seguro Popular: Cancer and the Fund for Protection from Catastrophic Illness !   Accelerated, universal, vertical coverage by disease with an effective package of interventions !  2004: HIV/AIDS !  2005: cervical cancer !  2006: ALL in children !  2007: All pediatric cancers; Breast cancer !  2011: Testicular and Prostate cancer and NHL !  2012: Colorectal and ovarian cancer
  9. 9. Engaging  breast  cancer  advocates:   REPORTE  ROSA:     MEXICO  
  10. 10. Lessons 1: Advocacy + evidence + action •  Non-governmental actors do unite around a common project with measurable goals and this enables engagement w/ government •  Evidence-Based Passion & Passion inspired Evidence –  Advocacy without evidence is likely to be misguided and will tend towards error –  The mission of evidence is weakened when neither inspired by nor applied to the needs of patients and people •  Methods for merging personal experience/advocacy and evidence have not been formally developed – never been rigorously studied
  11. 11. Lessons 2: Diagonal Approach to Evidence-based, Passionate Advocacy •  Advocating only for ourselves or our own disease, particular disease limits potential for impact: Huge responsibility for cancer, and especially breast cancer advocates •  The art of patient advocacy is going ‘diagonal’ –  Common demands across diseases – i.e. pain control –  Strengthen health and social systems –  Collaboration and cooperation strengthen your message •  ‘Neglected and emerging’ areas for goal development: –  where patients do not live long enough to advocate for themselves –  Survivorship challenges – long life with disease or symptoms– quality of life –  Mental health - …and the NCD movement
  12. 12. Lessons 3: Local and Global Inseparability: The opportunity-space? •  Addressing disparities: not months but whole lifetimes to be gained •  Recognize disadvantaged groups as part of a global solution •  Focus on prevention but do not stop there –  No prevent/treat dichotomization •  Harness global and national health system platforms •  Innovate in implementation, delivery and financing
  13. 13. Why might a global, inter- institutional, goal-based initiative contribute: •  Global evidence from children´s rights and MDGs •  MDGs post 2015 agenda •  NCD/UN agenda - UICC •  Global wake-up to new and emerging challenges to health in LMICs •  Knowledge base and treatment options for the disease •  Global accountability frameworks focussing on the health of women and children •  Frameworks for identifying priorities and measuring progress (GBD) •  Need for a Shared global vision that crosses divides: Patients, Providers, Global institutions
  14. 14. What might a global, inter- institutional, goal-based initiative contribute: •  Shared vision and ownership – ours; among ourselves –  to enable us to contribute more effectively to global and national initiatives •  “lighthouse effect” •  Better measurement of process and outcomes •  Generate more and better lives for women and their families and societies – motor of and for broader goals of social development •  Promote uncharted areas for action - that can contribute to global and women’s health •  Produce new knowledge that can help all women
  15. 15. Challenges and questions in designing a global, inter- institutional, goal-based initiative: •  Funding gap •  Specific yet inclusive •  Vertical and horizontal •  Relevance/Excellence: measurement •  Interim goals that are –  Achievable –  Instrumentally and intrinsically valuable to many –  Measurable –  Inspirational

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