Washington, DC., 7 de mayo de 2013

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. 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

4. 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.

5. 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

6. 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.

7. 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

8. Universal Health Coverage in Mexico
through Seguro Popular
Horizontal
Coverage:
>
54.6
million
Beneficiaries
Ver1cal
C
overage
Diseases
a
nd
I
nterven1ons:
E
xpanded
B
enefit
P
ackage

9. 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

10. Engaging
breast
cancer
advocates:
REPORTE
ROSA:
MEXICO

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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