Developing and sustaining high-quality care for children with cancer: the WHO Global Initiative for Childhood Cancer

ABSTRACT

Cancer is a major public health concern, impacting nearly 20 million people each year, and it is responsible for 1 in 6 deaths worldwide. The burden of cancer is increasing rapidly, straining health systems that are unable to prevent and manage the disease. Childhood cancer constitutes a significant and relevant public health challenge; it was the ninth leading cause of childhood disease globally, according to findings by the Global Burden of Disease 2017 study. Almost 80% of all children diagnosed with cancer live in low- and middle-income countries where treatment is often unavailable or unaffordable. As a result, only about 15–45% of these children survive compared with more than 80% in high-income countries. This represents a great health inequity.

Delivering on the mandate provided by World Health Assembly resolution 70.12, WHO together with St. Jude Children’s Research Hospital and other global partners launched the Global Initiative for Childhood Cancer at the United Nations General Assembly during the third High-level Meeting on the prevention and control of noncommunicable diseases in September 2018. The Initiative aims to increase global survival for children with cancer to at least 60% by 2030, while reducing suffering for all children with cancer. Five years after launching the Initiative, more than 70 countries across the World Health Organization’s 6 regions have advanced to different phases of action through implementation of the Initiative’s CureAll framework for action. Many successful approaches to implementing the CureAll pillars and enablers have demonstrated that improving care for children with cancer in low- and middle-income countries is possible as long as there is strong political will, multisectoral commitments and strategic investment.

With the understanding that where a child lives should not determine their capacity to survive, and to deliver on the mandate in World Health Assembly resolution 70.12, adopted in 2017, the World Health Organization (WHO) together with St. Jude Children’s Research Hospital and other global partners launched the Global Initiative for Childhood Cancer at the United Nations General Assembly during the third High-level Meeting on the prevention and control of noncommunicable diseases in September 2018. The Initiative aims to increase global survival for children with cancer to at least 60% by the year 2030, while reducing their suffering.

Cancer is a major public health concern, impacting nearly 20 million people each year, and it is responsible for 1 in 6 deaths worldwide (1). The burden of cancer is increasing rapidly, straining health systems that are unable to prevent and manage the disease. This results in avoidable and premature deaths, threats to health budgets and economies, and financial catastrophe for individuals and families.

Childhood cancer constitutes a significant and relevant public health challenge; it was the ninth leading cause of childhood disease globally, according to findings by the Global Burden of Disease 2017 study (1). Almost 80% of all children diagnosed with cancer live in low- and middle-income countries (LMICs) where treatment is often unavailable or unaffordable. As a result, only about 15–45% of these children survive compared with more than 80% in high-income countries (2).

The Global Initiative for Childhood Cancer will accomplish its goals through its two objectives: to increase the capacities of countries to provide quality services for children with cancer and to increase the prioritization of childhood cancer in national policies and program (3).

Five years since launching the Initiative, more than 70 countries across the 6 WHO regions have advanced to different phases of action through implementation of the 10 priority projects and interventions outlined in the Initiative’s CureAll framework for action (Figure 1).

FIGURE 1. The CureAll framework’s core projects for focus countries and phases of action to support implementation of WHO’s Global Initiative for Childhood Cancer (3).

Source: Figure 1 is used with permission from reference (3).

Many successful approaches to implementing CureAll’s pillars and enablers have demonstrated that improving care for childhood cancer in LMICs is possible with strong political will, multisectoral commitments and strategic investment.

In WHO’s African Region, four countries have completed their initial assessments and eight are currently progressing into the planning phase for CureAll implementation. By the end of 2022, three additional countries in the Region – Cameroon, Ethiopia and Uganda – had submitted a formal expression of interest to become an official focus country.

In the Region of the Americas, 17 focus countries and 4 countries in the initial phases of implementation have completed assessments of the capacities of their national health system and childhood cancer programs. Nine focus countries are planning for implementation, and the Dominican Republic, El Salvador, Panama and Peru are implementing their childhood cancer actions plans.

WHO’s Regional Office for the Eastern Mediterranean hosted a consultation in January 2021, convening stakeholders from different sectors – including representatives from ministries of health, pediatric oncologists, representatives from global and regional pediatric oncology associations, as well as the three levels of WHO – to outline a specific regional governance structure and to promote suitable modes of collaboration among the different partners under the leadership of WHO (4). A call for proposals to support the implementation of CureAll priority projects (Figure 2) was launched to encourage all Member States in the Region to take action on childhood cancer and on regionally agreed priorities. As a result of this call, six additional countries began implementing the Initiative’s priority projects, benefiting from funding from the WHO–St. Jude partnership. In alignment with the Initiative’s objectives, three of the six countries implementing the CureAll framework have developed national standards of care to improve the delivery of services for children with cancer. Childhood cancer has also been included as part of national cancer plans in Iran, Morocco and Palestine.

FIGURE 2. The CureAll framework: four pillars and four enablers to increase access to and the quality of care for children with cancer (3).

LMICs: low- and middle-income countries.

Source: Figure 2 is adapted with permission from reference (3).

In the South-East Asia Region, a regional collaborative network, known as the South-East Asia Childhood Cancer Network, includes 16 specialist centers in 10 Member States. The network has facilitated knowledge sharing and the exchange of best practices for providing high-quality care for children with cancer in the participating centers (5). One of the relevant achievements of this Network has been the establishment of a shared-care center model in Myanmar and Nepal, which contributes to improving access to care and treatment adherence, and to reducing the financial burden on families (6).

Multisectoral collaboration has facilitated the implementation of the CureAll pillars across the six WHO regions, supported by the Initiative’s enablers of advocacy, leveraged financing and linked governance (3). This has resulted in the prioritization of childhood cancer in national policies and programs that are in keeping with objective two of the Initiative. Childhood cancer was included in 20 national cancer control policies developed in 2022. In the Region of the Americas, this represented an increase of 62%, from inclusion in 8 policies in 2017 to 13 policies, in 2022 (7).

The development of new legislation has enabled progress toward the attainment of universal health coverage through the inclusion of childhood cancer in the minimum package of benefits in focus countries such as El Salvador, Ghana, Mongolia, the Philippines, and Zimbabwe (8, 9).

Many studies have demonstrated the favorable cost–effectiveness of childhood cancer interventions and the value of investing in childhood cancer programs (10-12). The key message from these studies is that small strategic investments can save lives and bring about overall improvements in health systems. The ratio of expenditures on childhood cancer compared with expenditures on breast cancer is 1:10, and this represents only 2–4% of global spending on cancer.

Childhood cancer constitutes a proxy for progress in the control of noncommunicable diseases, and strengthening care for children with cancer is also associated with having a stronger and more resilient health system. The Initiative has demonstrated that even in fragile and conflict-affected settings, such as in Palestine, Syria, Ukraine and Yemen, it is possible to maintain access to services thanks to the integrated global network that enables their continuation and to efficient service models that allow children to receive care in facilities in neighboring areas, owing to existing ties between providers, civil society organizations and researchers (13, 14).

The progress that has been achieved globally through the implementation of the Global Initiative for Childhood Cancer has demonstrated that improving the quality of care and outcomes for children with cancer is achievable when there are broad political commitments, strategic investment and strategic action plans led by governments and supported by multisectoral partnerships that include parent support and advocacy groups, private sector entities and philanthropic foundations.

Disclaimer.

Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health or the Pan American Health Organization.

Funding Statement

Funding. No financial support was provided for the development of the manuscript.