City Cancer Challenge

Access Accelerated and City Cancer Challenge (C/Can) have partnered since 2017 to develop locally relevant solutions to improve access to equitable, quality cancer care in cities. Cities play a central role in achieving the Sustainable Development Goals (SDGs). In 13 cities, C/Can supports a stakeholder-driven process that develops guidelines and tools for improved cancer care. For the past six years, C/Can has pioneered a decentralized approach to identifying cancer needs and developing responses in which local actors come up with city-wide solutions.

Flexible and long-term financial support from Access Accelerated enabled C/Can to grow from four to 13 cities with diverse priorities, ranging from early diagnostics to treatment and palliative care. By 2022, C/Can had reached over 59.6 million people, supported over 1,000 service providers, trained over 600 healthcare professionals, and developed nearly 100 tools for improved cancer treatment. C/Can’s projects have attracted additional investments, including 38 million USD of funding secured, and 69.8 million USD mobilized through the end of 2022 to support cancer care.

C/Can serves as a pioneering effort to drive locally-led implementation through carefully crafted public-private partnerships for cancer control. Its multi-disciplinary team approach creates ownership and interest. Going beyond traditional health financing support and leveraging the potential of multi-stakeholder partnerships raises awareness of the urgent need for sufficient resource allocation to cancer care and more broadly, to tackling NCDs. Partnerships foster a culture of engagement and collaboration, enabling sustainable, scalable, and equitable cancer solutions.

ACTIONS, OUTCOMES AND IMPACT IN 2022

C/Can’s achievements in 2022 and through the consortium are a result of its unique model of engagement and focus on ensuring that programming responds to people’s needs. The first step of C/Can’s process is a comprehensive stakeholder mapping to identify the key players in cancer care, who can do what, and the different sectors that might not be talking to each other. This stakeholder mapping considers all relevant local stakeholders from public, private, and civil society sectors, including city health leadership, regional/national government, cancer care providers, health insurers, academia, scientific societies, and patient organizations. Recognizing that these groups might not be used to working together, C/Can creates a City Executive Committee (CEC), which is a leadership body that brings together representatives from different organizations. This step of the process is essential in driving things forward as it gives equal representation and voice to all stakeholders at a collective level that they may not have had before. This process of engagement harnesses the willingness of stakeholders and openness to engage, thus allowing for communication, trust and collaboration as multiple partners work together towards a unified goal of equitable access to quality cancer care.

C/Can engages multiple stakeholders to identify and prioritize gaps through a needs assessment, which provides in-depth information on potential challenges in the health system, infrastructure, quality, and human resources. Stakeholders across the city work together to develop consensus on priority actions and document their needs in a situational analysis report. Once projects are planned, C/Can facilitates needs-based technical cooperation and capacity development from local and global experts to support teams of local cancer care experts to develop localized solutions.

The entire process is evidence-based and results-oriented to foster sustainable collaborations at very local levels. The impact of having local stakeholders actively involved in prioritizing gaps and collaborating to develop solutions allows C/Can’s projects to become locally embedded. In 2022, members of C/Can’s CEC became formal government advisors in Paraguay and Colombia. Access Accelerated enabled C/Can to grow from four to 13 cities with diverse priorities, ranging from early diagnostics to treatment and palliative care. By 2022, C/Can had reached over 59.6 million people, supported over 1,000 service providers, trained over 600 healthcare professionals.

C/Can’s commitments and models for strengthening cancer care resonate with many cities. The last round of applications in 2022 had over 90 cities, which is a tenfold increase from the first round of applications. C/Can’s model also produces impactful results for equity. By 2022, 36% of CEC members were female: substantially better representation than women’s average of 5% in leading positions in healthcare in LMICs. Moreover, through capacity-building exercises in 2022, a remarkable 89% of trainees reported improved skills and knowledge through pre- and post-training surveys.

C/Can’s work originated through funding from Access Accelerated in 2017. Over six years the success of its city-based model has catalyzed investment in local cancer care. C/Can raised over 3 million USD in 2021, and over 2 million USD in 2022.

Case study: Raising investments for local cancer care

Cities are complex — they have enormous potential to generate health, yet they require effective governance to meet this potential and ensure equitable access to quality health services. Cancer care offers a case in point. Many countries state a political commitment for action on cancer and (NCDs) yet national health authorities may struggle to build enabling environments for effective implementation of NCD strategies. The reasons for this stem from health systems building blocks to governance. C/Can brings a unique approach to this challenge by convening major decision makers in cities’ cancer care ecosystems to drive locally led, multi-stakeholder and multisectoral approaches for equitable, accessible, and quality cancer services.

C/Can’s work originated through funding from Access Accelerated in 2017. Over six years the success of its citybased model has catalyzed investment in local cancer care. C/Can raised over 3 million USD in 2021, and over 2 million USD in 2022.

How is C/Can raising investments to advance their work to improve local cancer care? With the organization’s nimble structure and expertise in health financing, it serves as a facilitator of last mile implementation by connecting global experts, knowledge, and funding to local stakeholders with the determination to address local needs and demands in cancer care. C/Can convenes local actors and works with them to identify key areas of growth and improvement for cancer service provision based on local evidence. C/Can then strengthens the technical capacity and global visibility of local partners’ work, making them central in developing innovative financing structures. C/Can’s convening power plays a key role in facilitating catalyzed investments, offering a lesson on how organizations can address complex problems by leveraging different types of stakeholders. In this way,

C/Can’s work also creates connective tissue, enabling the exchange of opportunities and resources from one end to the other. C/Can’s approach to health financing is not unnoticed. Global actors are increasingly paying attention. The International Finance Corporation joined forces with C/Can to identify up to four pilot cities to implement scalable cancer care projects. This partnership develops and co-funds market and pre-feasibility studies for cancer care interventions which can extend private sector investment beyond C/Can’s project cycles. New partnerships with global institutions and the private sector augment the pool of global resources that C/Can makes accessible to cities in its network. A whole-of-society approach that advances cancer care through collaboration, partnership, and local ownership is the cornerstone of the uniquely effective and sustainable model for which C/Can has earned global recognition.

CASE STUDY: Strengthening Capacity for improved cancer care

City-wide health workforces are at the forefront of effective and equitable service provision and management. Recognizing the challenges that complex diseases like cancer imply for health workers, C/Can works with local stakeholders to strengthen the skills, instincts, abilities, processes and resources that cities need to deliver quality cancer care. C/Can does this in multiple ways, ranging from training to global partnerships to knowledge sharing.

By using digital technologies, C/Can enables knowledge transfer among cancer care professionals. The partnership with Project ECHO demonopolizes knowledge through a series of virtual sessions on a range of cancer care topics. These sessions allow participants to share strategies they have implemented to tackle challenges at local levels. A distance education program with contact sessions based on principles of adult learning supports local cancer care workers in Yangon (Myanmar), Kumasi (Ghana) and Kigali (Rwanda) to enhance palliative care. In partnership with the American Society of Clinical Oncology, mid-career female oncologists in LMICs partake in virtual and in-person sessions to strengthen their skills as changemakers to become impact leaders and create lasting change for future generations of women in the cancer field.

C/Can also leverages the power of networks within and between cities to build effective and sustainable models to strengthen capacities for improved cancer care. This city-based approach drives global innovation through local channels and brings state-of-the-art cancer solutions to coalitions of stakeholders who are positioned to have the greatest impact. Such knowledge exchange facilitates the implementation of consensus-based, citywide practice guidelines across the continuum of care, and then building know-how for the implementation of those guidelines among a multisectoral coalition of cancer care providers from the public and private sectors. For example, in Asunción, Paraguay, C/Can worked with the Ministry of Public Health and Social Welfare, the Faculty of Medical Sciences of the National University of Asunción, the Social Security Institute, and the San Roque Group to develop guidelines for the diagnosis and treatment of breast and cervical cancer, both of which are now adopted at a national scale. The groundwork for this policy innovation was laid by C/Can’s city engagement process, which produced a needs assessment identifying cancer care priorities.

C/Can’s city networks including in Paraguay support the implementation of newly adopted cancer care guidelines by targeting key health systems capacities with tailored trainings driven by local stakeholders. To do this, C/Can takes a holistic and city driven approach whereby local professionals develop and carry out the workshops, thus ensuring responsiveness to local needs and capacities.

Across the cities in which C/Can works, city’s capacity needs are also met by leveraging local and global cancer networks, which often become embedded within local health systems. For example, members working closely with C/Can serve as formal government advisers in Asunción and at the department level in Cali, Colombia. Globally, technical support from partnerships with the American Society of Clinical Oncology and the International Agency on Research on Cancer pave the way for improved capacities at local levels. Strategic engagements with key stakeholders in cities and globally, enable C/Can to help to strengthen local capacities to provide high-quality, equitable, and sustainable cancer care.

C/Can’s multi-pronged approach to strengthening the capacity of local workforces for the delivery of equitable and quality cancer care reveals that diversifying entry points for NCD needs is essential. Moreover, it is critical that these varied approaches are oriented towards embeddedness as this enables long-term sustainability.