Cali in Colombia was the first city to join the City Cancer Challenge (C/Can) in 2017. The city, with the support of C/Can, broke ground in addressing the burden of cancer, bringing together a multisectoral approach for the first time, and setting the course for addressing cancer care through ten prioritised projects for the city.
The ten projects reflect the gaps in Cali’s cancer care services identified during the Needs Assessment, which was carried out by 186 healthcare professionals representing 21 cancer care providers from the public and private sectors, and included over 180 patient voices.
To ensure that these city projects and cancer care solutions initiated and developed through the City Engagement Process Framework (CEPF) continue to be implemented, monitored, evaluated and scaled-up, sustainability is embedded into the C/Can process and is a key pillar of the C/Can model. The selection of C/Can’s local sustainability partners is therefore critical in the sustainability of commitment, resources, progress and impact beyond the City Process and is based on eight selection criteria that were developed from experience and learnings on-the-ground.
Towards the end of 2019, Cali was ready to begin this phased transition of responsibility to local stakeholders. To take up the role of continuing local efforts, C/Can partnered with ProPacifico, an independent, not-for-profit organisation dedicated to sustainable development in south western Colombia, as its local sustainability partner.
Since then, despite the many and unique challenges presented by the global health pandemic in this last year, the city has made forward progress with the city projects, helping to ensure the long-term efforts of improving access to equitable and quality cancer care continues in Cali.
“Not only have we been able to withstand the health crisis, we have been able to make significant progress thanks to the efforts and dedication of city stakeholders and to the strong foundation laid by the C/Can process to ensure continued and long-term action even in the most challenging of situations. ” Maria Isabel Ulloa, General Director, Pro Pacifico
In a recent major achievement, a first-time collaboration agreement for the implementation of the management guidelines for the city’s prioritised cancers was formally signed on 23 July by the Secretary of Health of Valle del Cauca, the Secretary of Health of Cali and Cali’s leading hospitals and insurance agencies.
“This commitment from the health institutions represents a major step forward for improving quality cancer care in the city. Having the same set of guidelines provides a common language which will help the different institutions and the different areas within an institution to better communicate and collaborate, which will ultimately support the continuity of patient care in our city.” Miyerlandi Torres, Secretary of Health, Cali
The resource-appropriate guidelines for the management of breast, cervical, prostate and colorectal cancers prioritised by the city through the C/Can Needs Assessment were developed by local experts from a number of leading cancer care services in major hospitals of the city, including the Fundación Valle de Lili, the Imbanaco Medical Centre, and the University Hospital of Valle, with the support of Pro Pacifico and the National Cancer Institute of Colombia in collaboration with the American Society of Clinical Oncology (ASCO) and with the participation of experts nominated by C/Can partners: the American Society of Clinical Pathology (ASCP), the International Society of Nurses in Cancer Care (ISNCC), the Oncology Nurse Society (ONS), and the Latin-American Palliative Care Association. The guideline on paediatric leukemia, which has also been prioritised by the city, has been drafted and is currently set for international consultation.
The Ministry of Health supported and accompanied the process, and the National Cancer Institute completed the technical review of the documents. It is the first time that the city of Cali has an agreed set of cancer management guidelines, which implemented across the city will have an enduring impact on reducing the variability of cancer treatment and improving patient outcomes.
“This is a huge achievement by the Project Teams and was made possible through the efforts and commitment of everyone involved. With this formal agreement, Cali is pioneering how the city and country works together to improve cancer care for its people.” Dr Maria Fernanda Navarro, Regional Director for Latin America, C/Can
There has also been many other notable progress in city projects over the last 15 months, including:
- Improved quality diagnosis across the city
This past year has seen the completion and dissemination of a quality control manual for pathology labs across Cali. The manual is one of the main outputs of the Pathology city project and was developed alongside C/Can partner, the ASCP with the aim of strengthening the quality of processing samples by providing local pathologists with an easily replicable framework of good practices. With the delivery of the manual, the Pathology project is now completed.
“The quality control manual for pathology labs will have an immediate impact on the quality of care for cancer patients in our city. Having accurate and timely diagnosis prevents delays in accessing treatment and is critical to informing decisions around the most appropriate care for the patient, which in the end will help to improve outcomes for patients.” Dr. Maria Ximena Varela, Medical Pathologist, Imbanaco Medical Centre – University Hospital of Valle (one of the two Project Coordinators)
- Closing the skills gap
Accelerated progress has also been made in implementing the Human Resources Development Plan, one of the C/Can city projects. A big driver of the plan is addressing the disparities in training and certification of healthcare professionals, which was identified during the C/Can Needs Assessment and led by the project team, composed of the Deans of the Faculty of Medicine from all five universities in Cali, a healthcare provider and an insurance company. As a result, two online modules, Management of Oncology Services and Oncology Nursing were developed and launched this past March, bringing together 15 healthcare professionals and 25 nurses from around Cali.
- Strengthened public-private partnerships
Much of the past months has also been focused on building stronger corporate governance and risk management practices within the city’s health institutions, to provide an enabling environment to develop public-private partnerships, a core principle of the C/Can approach. As a result, discussions have opened between the Secretary of Health of Cali, insurance companies, healthcare providers and the private sector to collectively address and respond to the most common access barriers to cancer care.
Looking ahead: Building greater momentum
The immediate priorities for the city of Cali will continue to build on the momentum from the first part of this year, including the approval and endorsement of the completed Nuclear Medicine Quality Assurance Programme.
The coming months will also see a focus on strengthening capacity development in palliative care. Cali’s Secretary of Health will formally invite primary care professionals to complete the Palliative Care for Latin America online course, which was developed by C/Can’s collaboration partner e-Cancer, the Latin American Palliative Care Association (ALCP) and Colombian Palliative Care Association (ASOCUPAC). At the same time, the city’s primary care professionals will also be encouraged to use the Manual for Palliative Care for Primary Settings in Cancer, which was created by the Palliative Care project teams from Cali and the C/Can city of Asuncion.
Looking ahead, Pro Pacifico will also be involved with the updating of Colombia’s health and cancer control plan that will address the country’s cancer burden over the next ten years (2022-2032), which will be led by the Ministry of Health and the National Cancer Institute.
By the end of the year, the majority of the ongoing C/Can initiated city projects are expected to be completed. However, their finalisation does not mark the end. As part of C/Can’s sustainability approach, cities that complete the C/Can process will continue to be part of the C/Can cities network, with opportunities to contribute, exchange and share knowledge, learnings and good practices with other cities.