C/Can City Engagement Process: An Implementation Framework for Strengthening Cancer Care in Cities in Low- and Middle-Income Countries

Abstract

The effective implementation of locally adapted cancer care solutions in low- and middle-income countries continues to be a challenge in the face of fragmented and inadequately resourced health systems. Consequently, the translation of global cancer care targets to local action for patients has been severely constrained. City Cancer Challenge (C/Can) is leveraging the unique value of cities as enablers in a health systems response to cancer that prioritizes the needs of end users (patients, their caregivers and families, and health care providers). C/Can’s City Engagement Process is an implementation framework whereby local stakeholders lead a staged city-wide process over a 2- to 3-year period to assess, plan, and execute locally adapted cancer care solutions. Herein, the development and implementation of the City Engagement Process Framework (CEPF) is presented, specifying the activities, outputs, processes, and indicators across the process life cycle. Lessons learned on the application of the framework in the first so-called Key Learning cities are shared, focusing on the early outputs from Cali, Colombia, the first city to join C/Can in 2017. Creating lasting change requires the creation of a high-trust environment to engage the right stakeholders as well as adapting to local context, leveraging local expertise, and fostering a sustainability mindset from the outset. In the short term, these early learnings inform the refinement of the approach in new cities. Over time, the implementation of this framework is expected to validate the proof-of-concept and contribute to a global evidence base for effective complex interventions to improve cancer care in low- and middle-income countries.

Innovative Methodology for Strengthening a Multidisciplinary Team Approach in Cities in Low- and Middle-Income Countries

“…Prioritizing and leveraging existing local expertise and know-how is a central premise of C/Can's approach to technical cooperation support, 10 which on the basis of the…”

“…C/Can's City Engagement Process is a novel implementation framework, whereby local stakeholders lead a staged city-wide process over a 2- to 3-year period to assess needs and plan and execute locally adapted cancer care solutions. 10 This process is supported by a global network of partners and experts, bringing together governments, the civil society, and the private sector. The results of needs assessments in a first set of cities 10 identified a MDT approach as a recurring unmet need and priority, with specific efforts required to support its adoption at the local level.…”

“… 10 This process is supported by a global network of partners and experts, bringing together governments, the civil society, and the private sector. The results of needs assessments in a first set of cities 10 identified a MDT approach as a recurring unmet need and priority, with specific efforts required to support its adoption at the local level. 11…”

Trends in long-term cancer survival in Cali, Colombia: 1998-2017

“…Cancer survival in Cali shows a gap when compared to the United States, and it reaches several percentage points in the cancers prioritized by the Ten-Year Plan for Cancer Control in Colombia: Prostate (7.0), breast (9.2), cervix (12.8) and colorectal (9.7). Increasing coverage and improving quality is a priority in four main areas: 1) basic oncology services; 2) management of cancer services; 3) quality of cancer care and 4) community access and integrated care 27 , 28 .…”

“…La supervivencia al cáncer en Cali muestra una brecha cuando se compara con Estados Unidos y alcanza varios puntos porcentuales en los cánceres priorizados por el plan Decenal para el Control del Cáncer en Colombia: Próstata (7.0), mama (9.2), cuello uterino (12.8) y colorrectal (9.7). Es prioritario aumentar la cobertura y mejorar la calidad en cuatro áreas principales: 1) servicios oncológicos básicos; 2) gestión de servicios oncológicos; 3) calidad de la atención del cáncer y 4) acceso a la comunidad y atención integrada 27 , 28 .…”