Tajinder Tiwana, Account Director, Incisive Health
By 2030, an estimated three-quarters of all cancer deaths will occur in low- and middle-income countries (LMICs)[i]. The UN High-level Meeting on Universal Health Coverage (UHC) adopted a new political declaration in September 2023, emphasising member states' commitment to disease elimination within the UHC framework. According to the World Health Organization (WHO) only 39% of countries have benefit packages that included a core set of priority cancer services.
Many LMICs continue to grapple with a significant funding gap for cancer-related initiatives, hindering progress towards comprehensive UHC and better outcomes for patients and their families. In LMICs people living with noncommunicable diseases (NCDs) are more at risk of catastrophic health expenditure – this is the case for more than 60% of people living in LMICs with cancer[ii]. Those who face financial hardship often avoid or discontinue their care journey due to high out-of-pocket expensesii. While the development of UHC policies by public payers is a crucial step forward, many countries have a long way to go in providing comprehensive, quality cancer care by 2030.
So what solutions are there to help countries bridge the funding gap for comprehensive cancer care?
Simply asking governments to prioritise cancer and invest more is one answer. Certainly, governments need to take the lead in addressing the growing cancer burden and there are long term economic and societal benefits in doing so, but this is challenging given the fiscal contraints and competing priorities faced by many health systems in LMICs.
International funding models that were established to address the burden of infectious diseases in LMICs could be applied to efforts to eliminate cervical cancer, for example, given the evidence-based frameworks for prevention, screening and treatment programmes and the relatively low cost of interventions. However, this model is not suited to other cancers with complex and costly patient pathways. Therefore, our minds turn to more innovative funding and financing models that share the cost and administration across governments and other entities.
Innovative funding and financing models offer promising avenues to close UHC gaps for cancer care, provided solutions are tailored to local contexts and address specific affordability challenges. There are several good examples of government funds, innovative insurance schemes, and blended finance models, but many of these interventions are limited to isolated efforts for particular geographies or populations that struggle to be scaled as sustainable solutions that benefit large groups of patients.
The City Cancer Challenge (C/Can) model – bringing together a wide range of community stakeholders with the backing of local and national governments to tackle cancer at a municipal level – demonstrates the necessity of cross-sector collaboration for improving cancer care and outcomes in LMICs. To raise awareness of local financing innovations and initiate collaborations, their programme workshops have brought experts from local and international private companies together with, development finance professionals and C/Can stakeholders, enabling them to examine real-life projects and co-develop concrete solutions[iii].
Pretty much every working innovative funding model in cancer is driven through cross-sector collaboration. For example, the Nigeria Cancer Health Fund is a public private partnership to enable patient access to care without the consequence of financial hardships, making cancer a national priority and strengthening the cancer service ecosystem[iv]. Government has to be part of these collaborations to provide political leadership, bring key stakeholders together and help sustain programmes for the long term.
Milestones for policy engagement on funding and financing in cancer in 2024
The Global NCD Alliance Forum in Kigali in October will be an important opportunity to discuss how governments, particularly in LMICs, can sustain funding to address the rising burden of cancer. The NCD alliance have called for governments to increase national health budgets to expand the fiscal space for NCDs, advocating that UHC research should investigate financing models and coping strategies in the LMIC contextii. With many organisations already looking ahead to the Fourth UN High-Level Meeting on NCDs in 2025, this year is crucial in building momentum to inform the Political Declaration on NCDs and advance the global response between 2025 and 2030.
Closing the funding gap for cancer is not merely a matter of financial allocation; it requires a re-evaluation of spending priorities – both at a national and international level. As we mark World Cancer Day let’s make sure in 2024, we pave the way for comprehensive, sustainable, and equitable funding for cancer care, ultimately contributing to the realisation of UHC for all.
[i] International Agency for Research on Cancer. Priorities for cancer research in low- and middle-income countries: a global perspective https://www.iarc.who.int/news-events/priorities-for-cancer-research-in-low-and-middle-income-countries-a-global-perspective/ (2022).
[ii] NCD Alliance. Paying the Price: A deep dive into the household economic burden of care experienced by people living with noncommunicable diseases. https://ncdalliance.org/news-events/news/new-report-confirms-devastating-financial-impact-of-ncds-on-households-and-a-crippling-lack-of-data (2023).
[iii] City Cancer Challenge. Scaling Innovative Finance for Cancer Care. https://citycancerchallenge.org/projects/scaling-innovative-finance-for-cancer-care/ (2023).
[iv] IQVIA. Innovative Funding Models for High-Cost Non-Communicable Diseases (NCDs). https://www.iqvia.com/locations/asia-pacific/library/white-papers/innovative-funding-models-for-high-cost-ncds (2021).