Benchmarking infrastructure for cancer control in Commonwealth countries: a population-based observational study
Che L Reddy1, Cecilia Sousa2, Rifat Atun3
1Health Systems Innovation Lab, Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
Background:
Health systems in the Commonwealth perform suboptimally in relation to cancer control. We applied a proprietary health system analysis framework to benchmark cancer control infrastructure and explore the implications for health systems to enhance the cancer response.
Methods:
In this multinational, population-based observational study across all 56 Commonwealth countries, we analysed data across five health system infrastructure elements: imaging diagnostics (mammography), imaging diagnostics (CT), treatment (radiation oncology), treatment (surgery), and health-care providers (hospitals). Five indicators were prioritised on the basis of the availability of timely, comprehensive, consistent, standardised, and reliable data to assess the five elements and collectively provide a tracer for health system infrastructure availability for cancer control, the primary study endpoint. We collected data and conducted analyses to benchmark the availability of infrastructure against established international targets.
Findings:
The study was conducted between July 1, 2024, and Nov 25, 2024. The countries comprising the Commonwealth fall short of established targets for cancer control infrastructure, with diagnostics (mammography) as the only exception. The most substantial deficits are in imaging diagnostics (CT), health-care facilities, and surgery, particularly in Africa (13-24 times lower than the international targets), Asia (1-4 times), low-income countries (13-46 times), lower-middle-income countries (6-43 times), and non-small states (5-30 times). Major inequities in infrastructure availability are evident and the greatest disparities were observed in radiation oncology, with variations of 62 times by country income group, 47 times by world region, and eight times by state size.
Interpretation:
Our analysis reveals major infrastructure deficits in the Commonwealth, which could directly affect the availability of effective, efficient, equitable, and responsive screening, diagnosis, and treatment, leading to suboptimal patient outcomes. Infrastructure expansion could be informed by collecting timely, reliable, and standardised data on infrastructure as part of a Cancer Control Data Observatory, extending the Commonwealth pooled procurement mechanism, and fostering strategic public-private partnerships.
Funding:
Harvard University.
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