City Cancer Challenge (C/Can) – creating a world of quality and equitable cancer care

City Cancer Challenge (C/Can) - creating a world of quality and equitable cancer care
Photo Copyright: City Cancer Challenge. Photographer: Santiago Esteban

Cancer, according to the World Health Organisation (WHO), is a growing global health threat and also a leading cause of death worldwide – accounting for nearly 10 million deaths in 2020.

The WHO again indicated that the most common for 2020 in terms of new cases of cancer were: breast cancer with about 2.26 million cases; lung cancer with 2.21 million cases; colon and rectum cancer with 1.93 million cases, prostate cancer with 1.41million cases; skin cancer (non-melanoma) with 1.20 million cases; and stomach cancer, which had 1.09million cases. This development has made it imperative for countries to employ all necessary measures to curb the menace.

Fully aware of these, City Cancer Challenge – a foundation helping countries to amicably deal with the disease – believes the challenge of cancer requires a system-level approach; thus a focus on strengthening services and infrastructure, and access to essential medicines and technologies.

The CEO, Dr. Susan Henshall, and Regional Director for Africa and Europe
Mrs. Sophie Bussmann-Kemdjo, have revealed much more – including their role in supporting countries deal with cancer – in an engagement with the B&FT.

Photo Copyright: City Cancer Challenge. Photographer: Santiago Esteban

B&FT: Tell us about the City Cancer Challenge Foundation (C/Can) and the kind of work it does?

C/Can: City Cancer Challenge (C/Can) was launched at the 2017 World Economic Forum Annual Meeting in Davos by the Union for International Cancer Control (UICC) with the vision of creating a world with quality and equitable cancer care for all. Created as a coordinated response to support cities in resource-limited settings in reducing their growing cancer burden, it was at the same time a recognition of the untapped potential of taking an integrated approach to three of the UN’s 17 Sustainable Development Goals (SDGs), health, sustainable cities and partnerships.

Moving to a standalone Foundation in 2019, C/Can has built a community of cities around the world connected in their shared ambition of improving access to quality cancer care by fuelling the city’s innovation and leadership to transform cancer care from the ground-up. This catalytic support involves local investment in the people, and empowering and supporting them with the knowledge, insights and data to inform the implementation of sustainable, scaleable cancer care solutions which meet local needs.

B&FT: What measures are the foundation employing to further achieve its objectives?

C/Can: To support the successful implementation of cancer care solutions in some of the most resource-challenged settings, C/Can has developed, tested and adapted a new framework – the ‘City Engagement Process Framework’ (CEPF). The framework outlines support for participating C/Can cities across a two-to-three-year period, during which they identify, plan and implement solutions to close major gaps in quality cancer care – from diagnosis to treatment to palliative and supportive care. C/Can recognises that each city is unique in its social, economic and environmental development, which means there is no one-size-fits-all city cancer treatment solution.

What the CEPF provides is a tested framework that can be applied and adapted to lower income settings through a staged process which delivers a set of outputs, processes and practices toward strengthening the local health system for cancer care.

B&FT: How has C/Can impacted various countries, such as Ghana, with its support to improve access to equitable, quality cancer care?

C/Can: C/Can’s strength lies in its catalytic force. Many of the city initiatives taking place in participating cities are often happening for the first time. For example, the convening of a City Executive Committee – a group of decision-makers who are driving cancer care solutions forward in their city – is often the first time such a diverse group of local stakeholders have been brought around the table to align on a city-wide approach and plan for cancer care.

The Situational Analysis that is conducted in each city is also often the first time a city has a clear view and understanding of what’s missing, what’s needed, and what could work better when it comes to improving equitable access to cancer care services in the city.

The support of C/Can also help to accelerate the work and progress by bringing together local and international experts to develop plans, procedures and guidelines that help define the benchmark and be a reference point for quality cancer management.  There is also a noticeable shift in mindset among individuals as they work together for the first time to explore a new way of approaching this long-standing challenge. The work is pioneering, and importantly focused on sustainable solutions for lasting impact to the city and beyond.

Photo Copyright: City Cancer Challenge. Photographer: Santiago Esteban

B&FT: How many low and middle-income countries have you supported or are supporting currently?

C/Can: Today, 11 cities around the world are part of the C/Can city network: including the cities of Cali (Colombia), Asuncion (Paraguay), Yangon (Myanmar), Kumasi (Ghana), Kigali (Rwanda), Tbilisi (Georgia), Porto Alegre (Brazil), Greater Petaling (Malaysia) and Leon (Mexico); and most recently Arequipa (Peru) and Nairobi (Kenya). Combined, these cities are reaching over 54 million people.

B&FT: How many more African countries do you intend extending your support to in the near future?

C/Can: As we see more and more cities around the world eager to take the lead in health, there is an earnest ambition to grow the city network to support more cities.

Currently, there is a wider shortlisted group of cities from all regions, including Africa, still undergoing due diligence. The growth of the C/Can city network will progress in line with the cities’ overall readiness and C/Can’s capacity to ensure it can continue to provide the best quality support for each city.

B&FT: Tell us about your initiative to prioritise quality and timely cancer diagnosis in low-and middle-income countries to close the cancer care gap. And what are some of the barriers that impede access to timely and accurate diagnosis?

C/Can: Since its inception, C/Can has been supporting cities to strengthen their cancer care capacity, including the diagnostic capacity of cities. Recently, the German Federal Ministry for Economic Cooperation and Development (BMZ) has committed to bolster efforts to improve cancer care in Kumasi. The six-month city initiative to strengthen timely and accurate cancer diagnosis is implemented in cooperation with C/Can and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) on behalf of the BMZ.

The project involves working with a multi-stakeholder group of global partners and local teams to address the barriers impeding cancer patients from receiving an accurate and timely diagnosis. These barriers often include a lack or absence of infrastructure and technological capabilities, inadequate levels of staff training and qualification, deficient standardised diagnostic procedures and quality standards, as well as fragmented or outdated information systems.

This new commitment and level of support will help to strengthen and accelerate all the collective efforts of the city of Kumasi and Ghana, and ultimately ensure healthcare workers have the data they need, and when they need it, to better inform clinical decision-making.

B&FT: Kumasi was the first African city to be selected to join C/Can at the beginning of 2018. What have been the major improvements and developments since then?

C/Can: We have been encouraged by the early achievements and proud of the recent progress that has been made since Kumasi joined City Cancer Challenge. In that time, Kumasi’s city stakeholders have been on a journey of working together to help advance cancer care solutions for the city and its people.

One of the first steps taken in Kumasi was to create the City Executive Committee (CEC), which brings together decision-makers, leaders and experts from the city, the Ministry of Health, the different hospitals and academic institutions in Kumasi, and from civil society and patient support groups. It was the first time in Kumasi that such a diverse group of stakeholders have come together to build consensus, agree on shared goals and collectively arrive at solutions.

Along with creation of the Technical Committee and city project teams, individuals and organisations have the opportunity to take part in substantive discussions about the current and future state of cancer care in the city; and through the C/Can city initiative, they are able to move forward on actions collectively.

For example, one of the foundational parts of the City Engagement Process is a Needs Assessment, which involved contributions from over 250 healthcare professionals from 38 institutions in Kumasi and across Ghana. This robust process of gathering insight on the city’s cancer services, including gaps and needs, helped to provide a strategic roadmap for the city and ultimately a shared vision for the future of cancer care in the city.

Looking back to that time, and to where Kumasi is now, it is incredibly inspiring to see the progress that has and is being made – particularly in light of the global pandemic challenge. For example, last year the Cancer Registry was officially relaunched after 12-months of collective effort to ensure the city has the capacity to collect and manage quality, relevant and timely cancer data.

The city project teams are also working on finalising a number of development plans, along with cancer management guidelines. These documents are vital because they not only represent the first of its kind for the city, they will also set the benchmark for delivering quality cancer care to the people of Kumasi.

Through the support of C/Can and a network of global partners, five palliative care experts have completed a fellowship by the World Health Organisation; two separate delegations from Kumasi have visited C/Can’s reference centres, the Mayo Clinic and the Palliative Care Association in Uganda, with a number of other exchanges to take place on the continent over the next couple of months.

And, most recently, Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) committed to supporting the existing efforts to improve cancer care in the city, through a six-month city initiative aimed at strengthening the city’s diagnostic capacity. The project is currently being implemented by C/Can and city stakeholders in Kumasi, along with the support of Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) on behalf of the BMZ. With this level of support, it means that efforts and progress can be accelerated even further.

B&FT: Cancer has been declared by the World Health Organisation (WHO) as a growing global health threat.  What measures should African countries employ to curb this menace?

C/Can: Cancer is a complex issue. Which means that we need data, that we cannot do it alone, and that we need to approach the challenge of cancer from a systems lens. Much of C/Can’s experiences working with cities might also be applied at country level. For example, both national and local policymakers are best placed if they have data to inform policies and plans to address priority gaps in cancer care, so as to optimise the available capacities and resources.

Some of the lessons learned from working to support cities is that identifying, designing and implementing solutions cannot be done through a siloed effort. A multisectoral approach is needed, with the involvement of key stakeholders who are committed to a shared, common goal.

The challenge of cancer also requires a systems-level approach; meaning a focus on strengthening services and infrastructure, access to essential medicines and technologies, developing the health workforce, information systems, governance and financing to support across the continuum of cancer care.

National governments can look to cities to support system strengthening. Cities are helping to drive health innovation, solutions, processes and policies which are strengthening health systems for cancer care as a whole. As they work on the ground with local communities, cities are the most effective vehicle for local implementation; it makes sense that local, regional and national governments work together to meet patient needs and address the challenge of equitable access to cancer care.

B&FT: C/Can is spearheading the Global Coalition for Cancer Diagnostics launch, why is this initiative so crucial?

C/Can: The Global Coalition for Cancer Diagnostics is an initiative that aims to expand upon the current efforts being made in Kumasi, to help further accelerate action to close the gap in quality and timely cancer diagnosis.

This week’s call to join the coalition comes at a time when extraordinary advances are taking place in digital health technology. This has the potential to open-up new opportunities and solutions to address the barriers faced by low-income countries.

It also represents one of C/Can’s core approaches, a collective, multisectoral approach whereby all relevant actors – governments, civil society, the private sector and healthcare providers and professionals – work together to help problem-solve, co-create solutions, share and exchange knowledge… and all with a local lens.

The local lens is a critical point. The voices of city stakeholders are central to the Coalition. Through this group, international and local experts will work hand-in-hand to develop and implement diagnostic solutions that take into account the local context, are fit-for-purpose and help to build local capacity.

Through this approach, we hope to effect large-scale change that has lasting impact in Kumasi, with the city ultimately serving as a leading example for other cities around the world seeking to deliver best practices in cancer diagnosis.

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