Asuncion, one of the first four City Cancer Challenge (C/Can) learning cities, has made remarkable progress in improving cancer care coordination, standardisation, and quality since joining C/Can in 2017. Guided by the City Executive Committee, this transformation prioritised projects aimed at enhancing cancer service delivery and strengthening coordination among local healthcare providers and community, and policymakers to address the fragmented cancer care landscape.
This collaborative approach proved critical when Asuncion received a donation of six essential oncology medicines from Amgen via Direct Relief. By establishing a solid foundation for service readiness, the city was better prepared to deliver quality patient care, address the most urgent cancer care needs and priorities, and ensure the best possible outcomes for these donated medicines.
Our partnership with C/Can aims to build a more resilient health system for Asuncion and Paraguay, ensuring sustainable access to life-sustaining cancer medicines and care now and for years to come.
Darryl Sleep, Head of Global Public Health, Amgen.
Launched in 2022, the Readiness for Access to Breast Cancer Oncology Medicines in Paraguay project focuses on enhancing service readiness by streamlining diagnostic procedures and improving capacity to deliver quality treatment for cancer patients across a network of five institutions: Instituto Nacional del Cáncer (INCAN), Hospital de Clínicas de la Universidad Nacional de Asunción (HC-UNA), Hospital Nacional de Itauguá (HNI), Hospital Materno Infantil San Pablo (HSP), and Laboratorio Central de Anatomia Patológica (LCAP). In August 2024, the Minister of Health, Dr. María Teresa Barán, welcomed an international delegation from C/Can and its partners, Direct Relief and Amgen, to reaffirm the commitment to continue the project.
This health systems strengthening effort complements the access scheme supported by Direct Relief and Amgen that includes a donation of those six essential oncology medicines needed to treat the estimated breast cancer patients that test positive for human epidermal growth factor receptor 2 (HER2) in Paraguay, which typically represent up to 20% of total breast cancers.
Over the past two years, we have collaborated closely with C/Can in the comprehensive Readiness Program to ensure that required cancer medicines can be properly utilised in the eligible breast cancer patients in Asuncion at the right time and at no cost. It has helped alleviate the burden on lower income patients, their families, and the country’s healthcare system.
Tom Roane, Vice President of Corporate Engagement and Strategy, Direct Relief
A comprehensive process mapping of the services at the five participating healthcare institutions identified institution-specific gaps and areas for optimising workflows and improving quality. The mapping revealed key opportunities for intervention, including process optimisation, service and infrastructure upgrading, and training of healthcare professionals.
Currently in its third year of implementation, the project has already produced tangible results for the institutions treating the majority of cancer patients in Paraguay. These include:
- Improving laboratory processes to guarantee samples quality, traceability, and diagnostic accuracy
The project revitalised the previously abandoned local pathology laboratory information and management system (SIGAP), which had suffered from a lack of investment and equipment. In addition to the revitalisation, a new preanalytical module has been introduced. SIGAP is now operational at four of the five institutions: HNI, INCAN, HSP, and Laboratorio Central de Anatomia Patológica, enabling the laboratories to work as a network and share clinical information efficiently and securely. A new feature of SIGAP allows registration and labelling of specimens with the use of barcodes right from the operating room service, improving traceability, minimising errors, and optimising system efficiency.
- Renovating pathology laboratories to meet local and international quality standards
Renovations at both INCAN and HNI laboratories have expanded their pathology service capacity to meet growing demand. Essential laboratory equipment was also installed, ensuring lab professionals can deliver work that meets both city-defined and international quality standards.
- Adopting quality control processes to reduce turnaround time in pathology reporting from 40 to 15 days on average
The training of laboratory staff on quality management systems and temporary staff at HNI and INCAN has further reduced pathology report turnaround times by 60% and 40%, respectively.
- Developing an interoperable digital information solution for a smoother and simpler patient journey
To streamline the patient journey and facilitate patient tracking, a dedicated open-source digital tool, C/Can Soft, was developed. The solution is being implemented across participating institutions and serves as the primary tool for healthcare providers to register patients and select eligible candidates to receive donated medicines through Direct Relief. Additionally, C/Can Soft has been integrated with existing public health information systems, enabling the optimal use of clinical data to generate a complete and consolidated overview of patient information for more effective care delivery.
- Upgrading the main public cancer care facility’s pharmacy service to improve worker safety and medicine quality
Safe and effective preparation of medicines requires specialised infrastructure. To mitigate occupational and accidental exposure risk to toxicity for healthcare professionals, the project modernised the preparation area for cytotoxic medicines at INCAN’s pharmacy service. This upgrade ensures minimised exposure risks to health professionals and high-quality medicines for patients.
- Enhancing the patient experience by improving patient-dedicated infrastructure
Improving the patient experience, including patient comfort, is a key priority of the project. HNI’s mastology clinic now has a covered outpatient waiting room, protecting patients from inclement weather. At INCAN’s day hospital, a new chemotherapy room with expanded capacity has been created, including 10 new chemotherapy chairs and 36 fully refurbished chairs, providing 46 patients a more comfortable environment to undergo their treatment.
The C/Can Readiness for Access to Oncology Medicines Project in Paraguay had a transformative impact on our Anatomic Pathology service. The project extended far beyond providing cancer medicines, it optimised every stage, from receiving samples to analysis, and achieved the long-held dream of digitising the service. This initiative sets a lasting precedent for high-quality laboratory standards in our country, which ultimately benefits our patients.
Dr. Cinthia Sosa, Pathologist and Quality Head, INCAN.
Building on the learnings from Asuncion and with support from Amgen, the project in Asuncion has been expanded to a Readiness Programme and will be implemented in other cities in the C/Can network, starting with Kumasi by the end of this year, and a third city in 2025. As C/Can’s flagship service readiness initiative, the Readiness Programme aims to implement priority solutions at a healthcare facility level, deliver quality patient-centric care, and achieve the best possible outcomes from oncology medicines.
The continued commitment to quality improvement by local stakeholders and strong engagement by the participating institutions and the Ministry of Health have been key to delivering tangible results that go well beyond the project lifespan in the city. These lessons will guide our expansion to other cities.
Beatriz Hornburg, Project Director, C/Can.
