Table 5.

List of 54 selected right-to-health indicators in breast cancer care and management

Health service delivery
Structural indicators
1. In the NCP or NCDP there is a strategy to implement population-based breast cancer screening
2. In the NCP or NCDP there is a strategy to implement access to radiotherapy
3. In the NCP or NCDP there is a strategy to implement palliative/supportive care
4. In the NCP or NCDP there is a strategy to implement survivorship care
5. In the NCP or NCDP there is a strategy to implement end-of-life care
Process indicators
6. There is a referral system in place from primary care to oncology services
7. There is a specified maximum waiting time between diagnostic suspicion in primary care and the first appointment with an oncologist
8. There is a specified maximum waiting time between the confirmed diagnostic and the first appointment for treatment
9. The national diagnosis guidelines involve pathological evaluation in line with ESMO or ASCO recommendations
10. The number of radiotherapy units is at least as high as the optimal threshold set by the IAEA (one radiotherapy unit per 500,000 population)
Disaggregated by geography
11. There is a referral system in place from the breast unit to psychological care
Disaggregated by geography
12. There is a trained member of staff acting as patient navigator in the breast unit
Disaggregated by geography
Outcome indicators
13. Proportion of suspected breast cancer patients with a first consultant appointment within 2 weeks of primary care referral
14. Proportion of women with advanced breast cancer (stage IV) at diagnosis
Disaggregated by wealth quintile and ethnicity
15. Proportion of breast cancer patients forgoing or postponing care because of limited availability
Disaggregated by wealth quintile and ethnicity
16. Proportion of breast cancer patients forgoing care because of affordability
Disaggregated by wealth quintile and ethnicity
17. Proportion of breast cancer patients who receive palliative care
Disaggregated by wealth quintile and ethnicity
18. Proportion of women terminally ill with breast cancer who receive end-of-life care
Disaggregated by wealth quintile and ethnicity
Health system financing
Structural indicators
19. The NCP or NCDP addresses costs of implementation of the breast cancer strategy
20. Share of government spending and out-of-pocket payment out of the total spending on health per capita
21. The state has a social health insurance system
Process indicators
22. The social health insurance system covers diagnostic services for breast cancer (i.e., biopsy, mammogram and ultrasound)
23. The social health insurance system covers breast cancer treatment (i.e., hormone therapy and chemotherapy)
24. The social health insurance system covers radiotherapy for breast cancer
25. The social health insurance system covers palliative care for breast cancer
Outcome indicators
26. Proportion of costs covered for breast cancer care by the social health insurance system
Medicines
Structural indicators
27. There is an official national medicines policy to provide access to essential medicines
28. The NCP or NCDP mentions breast cancer medicines included in the WHO Essential Medicines List
Process indicators
29. Proportion of breast cancer medicines included in the WHO Essential Medicines List that are available in the country and covered by public funding
Outcome indicators
30. Proportion of hospitals with palliative medicines shortage
Disaggregated by geography
Health workforce
Structural indicators
31. The state has a national health workforce strategy
Process indicators
None selected
Outcome indicators
32. Prevalence of certified oncologists per 1,000,000 population
Disaggregated by geography
Health information systems
Structural indicators
33. The state law requires informed consent to treatment and other health interventions
34. The NCP or NCDP protects the right to seek and receive health information
35. The NCP or NCDP addresses communication of information throughout the pathway of care for breast cancer, from screening through to referral, diagnosis, treatment options and palliative care
36. The NCP or NCDP addresses the needs of patients from culturally and linguistically diverse backgrounds
37. The NCP or NCDP addresses participation of patients in decisions that affect them
Process indicators
38. The personnel in the breast unit are trained to communicate information on diagnosis and treatment options, including side effects and survival, repeatedly, verbally and in writing, in a comprehensive and easily understandable form to patients
39. The personnel in the breast unit presents all options available to the patient beside a mastectomy, and explains in an easily understandable way psychological distress that may be associated with a mastectomy
40. The personnel in the breast unit discusses breast reconstruction techniques individually taking into account anatomic, treatment- and patient-related factors and preferences
41. The breast cancer unit uses trained interpreters when communicating with patients from culturally and linguistically diverse background
42. The breast unit has a participatory process in place to include patients into decisions that affect them individually
Outcome indicators
43. Proportion of breast cancer patients who feel they have received sufficient, comprehensive and easily understandable information, including on treatment side effects and survival, to be involved in decisions about their care
Disaggregated by wealth quintile, ethnicity, and language
44. Proportion of breast cancer patients who feel they have been involved in decisions about their care
Governance and leadership
Structural indicators
45. The Constitution, Bill of Rights, or other statute recognises the right to health
46. The NCP or NCDP addresses accountability of the state and health institutions
47. The NCP or NCDP includes a protection against discrimination
48. The NCP or NCDP includes an explicit commitment to universal access to cancer services and treatment
49. The NCP or NCDP includes a set of targets and progress indicators specific to breast cancer
Process indicators
None selected
Outcome indicators
None selected
Underlying determinants of breast cancer
Structural indicators
None selected
Process indicators
None selected
Outcome indicators
None selected
Accountability and redress
Structural indicators
50. There is an accessible pre-judicial mechanism to lodge complaints alleging breach of obligations connected to the right to health
Process indicators
51. The breast unit has a formal complaints mechanism for patients
Outcome indicators
None selected
Additional indicators suggested in round 1 and selected in round 2
52. Proportion of the population at risk participating in the screening programme
53. Prevalence of certified nurses per 1,000,000 population
54. The State has ratified key human rights treaties recognising the right to health