Academic journal article Bulletin of the World Health Organization

Innovative Public-Private Partnership: A Diagonal Approach to Combating Women's Cancers in Africa/Partenariat Public-Prive Novateur: Une Approche Diagonale De la Lutte Centre Les Cancers Feminins En Afrique/Innovadora Asociacion Publico-Privada: Un Enfoque Transversal Para Combatir Los Canceres Femeninos En Africa

Academic journal article Bulletin of the World Health Organization

Innovative Public-Private Partnership: A Diagonal Approach to Combating Women's Cancers in Africa/Partenariat Public-Prive Novateur: Une Approche Diagonale De la Lutte Centre Les Cancers Feminins En Afrique/Innovadora Asociacion Publico-Privada: Un Enfoque Transversal Para Combatir Los Canceres Femeninos En Africa

Article excerpt

Introduction

Every year cervical cancer kills an average of 275 000 women and five sixths of these deaths occur in low- and middle-income countries. In sub-Saharan Africa, for example, the incidence of cervical cancer and breast cancer is no higher than in other parts of the world, but the risk of death among women with either disease is much higher than in high-income countries--eight times higher in the case of cervical cancer--because African women face enormous barriers to treatment. (1,2) If case-fatality is to be reduced, access to primary prevention, screening, treatment and palliative care will need to be facilitated and women's cancers will have to be prioritized in countries' health agendas.

Pink Ribbon Red Ribbon (PRRR), launched in September 2011, is an innovative public-private partnership that supports African and Latin American countries in accelerating the implementation of their national strategies for the control of women's cancers. The partnership consists of four organizing members--the George W Bush Institute, the United States President's Emergency Plan for AIDS Relief (PEPFAR), Susan G Komen for the Cure and the Joint United Nations Programme on HIV/AIDS--as well as Becton, Dickinson and Company, the Bill & Melinda Gates Foundation, the Bristol-Myers Squibb Foundation, the Caris Foundation, GlaxoSmithKline (GSK), IBM, Merck, QIAGEN and other organizations with more limited engagement. It seeks primarily to reduce mortality from cervical cancer by 25% between 2012 and 2016 among the women screened and treated through the programme and to reduce deaths from breast cancer by promoting early detection. Specifically, PRRR focuses on improving access to the human papillomavirus (HPV) vaccine, increasing awareness of breast and cervical cancer prevention, diagnosis and treatment and reducing the stigma that so often surrounds a cancer diagnosis.

PRRR builds primarily on the PEPFAR platform and operates as a country-aligned partnership. Currently engaged in Botswana and Zambia with PEPFAR providing some support to nine additional countries--Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, South Africa, Uganda and the United Republic of Tanzania--PRRR aims to create innovative implementation models that can be used and scaled up globally. This paper outlines how PRRR supports countries and the lessons learnt after one year of implementation.

Approach

Diagonal integration

PRRR takes a diagonal approach to cancer control. This consists of leveraging existing--usually vertical--programmes focused on achieving disease-specific results with measures designed to enhance health systems more generally, often by integrating the activities of different disease programmes. (3) A diagonal approach requires: (i) entry points for programme integration based on overlapping health services or patient populations; (ii) the identification of those health systems into which certain services can be integrated; and (iii) the development of a strategy for broader health systems strengthening.

Programmes for the control of human immunodeficiency virus (HIV) infection provide an ideal platform for the integration of cervical cancer control services because most are well funded, decentralized and designed to provide longitudinal care. PEPFAR-supported HIV interventions serve as PRRR's primary integration point for cervical cancer screening and treatment. PRRR's initial focus is on settings where the prevalence of HIV infection is high. In sub-Saharan Africa, countries having the highest burdens of HIV infection are those that also have the highest age-adjusted cervical cancer incidence and mortality rates/partly because HIV-positive women are at higher risk of developing cervical cancer. (4-6) In countries with strong, decentralized HIV service delivery systems, it is sensible and feasible to integrate HIV and cervical cancer services, a process that can be greatly facilitated by the experience these countries have gathered in the area of chronic disease management. …

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