How C/Can is working with its partners to improve diagnostics in LMICs

Diagnostics for Better Cancer Care

C/Can’s experience across Africa, Asia, Eastern Europe and Latin America has taught us that improving access to treatment—and thereby improving equalities in outcomes—means identifying, understanding and removing barriers in the area of diagnostics, notably pathology and diagnostic imaging.

As Dr Susan Henshall, C/Can’s CEO points out, the organisation’s network of cities is focused on improving access to quality cancer diagnosis. “Quality-assured diagnosis is often a low priority in the cancer care continuum and even more so in countries where health resources are scarce. Improving local access to accurate and timely diagnoses of cancer is a critical and integral part of C/Can’s engagement with cities. “

That’s why, along with experts in pathology and diagnostic imaging, business leaders, innovators, civil society, governments, healthcare providers and local healthcare professionals from organisations such as Allm Inc, the American Society for Clinical Pathology (ASCP), the International Atomic Energy Agency (IAEA), Roche Diagnostic, SmartReporting and Thermo Fisher Scientific, we’re supporting cities throughout the C/Can network. This means strengthening cities’ diagnostic capacity through complementary efforts across the health system from training staff and standardising diagnostic reporting to improving infrastructure and deploying health technologies.

Realising this ambition means identifying existing capacities, regulations and local needs, notes Isabel Mestres, C/Can’s Director of Global Public Affairs:  “Our aim is to transform the way we approach cancer diagnostics in low-income countries and co-create solutions together, giving voice to our cities and empowering healthcare workers on the ground who are helping to make life-saving decisions every day.”

The C/Can way

Since its launch in 2017, C/Can has been committed to an evidence-based and pragmatic approach in which interventions, decision-making and resource allocation are based on accurate and reliable evidence.

One of the foundational pieces of C/Can’s City Engagement Process is a Needs Assessment that provides in-depth information on the quality and capacity of cancer care services in a city. It covers core elements of cancer care including radiology and nuclear medicine, pathology and laboratory medicine, medical oncology, radiotherapy, surgery, and supportive and palliative care.

C/Can’s Needs Assessment is a critical step in the process as it provides data that can inform the identification of a city’s key capacities, major needs, and priority actions to address these gaps. It also creates a baseline for continuous monitoring and evaluation of progress in quality cancer care delivery over time, creating a solid foundation for long-term planning.

Starting in 2017, C/Can iteratively developed a City Needs Assessment Questionnaire in collaboration with a multidisciplinary group of cancer care experts from across regions, to gather data on the capacity to deliver quality cancer treatment and care services in a given city.

City Needs Assessment Questionnaire

The City Needs Assessment Questionnaire is an evidence-based tool designed to systematically collect data on the quality and capacity of cancer care services in the city while addressing the extent to which patients are placed at the centre of care by assessing community access and integration of care within the city.

The questionnaire collects more than 1,100 data points and is divided into five key areas:

  1. Management of cancer care services
  2. Core cancer care services:
    • Diagnostics (radiology, nuclear medicine, pathology, and laboratory medicine)
    • Clinical (medical oncology, paediatric oncology, radiotherapy, cancer surgery, and palliative and supportive care)
  3. Quality of cancer care
  4. Community access and integrated care
  5. Healthcare workforce and training

For each section, the questionnaire poses key questions on infrastructure, healthcare workforce and quality to gather a snapshot of the services available and identify gaps. The questions focus on the capacity to deliver quality services, rather than on the therapeutic effectiveness of any specific interventions. It is intended as an operational tool to provide evidence to guide decision making and prioritization, rather than as an academic study.

Zoom in on Diagnostics

When it comes to diagnostics, two of the main challenges identified by C/Can cities throughout the Needs Assessment are a lack of capacity in terms of clinical and pathology laboratories, which are essential for timely diagnosis, and medical imaging equipment and facilities.

For example, in Asuncion, Paraguay, our stakeholders highlighted a lack of quality standards for sample processing in laboratories, while in Yangon, Myanmar, there is no Laboratory Information Management System and a general lack of equipment. Kumasi, Ghana, noted that there was no accreditation for laboratory facilities, and Kigali, Rwanda, identified a longstanding need for basic histopathology and clinical laboratory services.

Similarly, Tbilisi, Georgia, reported a lack of standardised reporting for radiology and the need to increase capacity for PET-CT services, while Porto Alegre, Brazil, is unable to transfer medical imaging reports between institutions. Cali, Colombia underscored the need for PET scanners and a lack of quality control in its nuclear medicine service, along with prolonged waiting times for ultrasound examinations. Porto Alegre also reported difficulties in accessing medical imaging results for ambulatory staging and underfinancing of diagnostic and interventional radiology.

C/Can milestones

In response, over recent years, our cities have already made significant progress, logging an impressive number of achievements.

For example, in Cali and Porto Alegre, teams of local experts developed a Quality Assurance Programme for Nuclear Medicine Equipment and a Pathology Quality Control Programme respectively that were endorsed by the City Executive Committees.

In Asuncion, a national regulatory standard for pathology and cytopathology laboratories has been agreed.

In Porto Alegre, the Municipal Secretariat of Health published a collective notification to local labs to observe the Pathology Quality Control Programme requirements as endorsed by the C/Can City Executive Committee in 120 days, while passing a city level resolution on pathology quality control.

C/Can Diagnosis project portfolio at a glance

  • Cost efficiency: Increase the efficiency and optimisation of financial coverage of priority diagnostic and treatment techniques
  • Early diagnosis: Increase access to early diagnosis of lung cancer and melanoma
  • Imaging: Harmonise and increase access to quality diagnostics imaging for cancer care
  • Nuclear medicine: Increase access to quality nuclear medicine services
  • Pathology: Improve quality and standardisation of pathology diagnosis
  • Paediatric oncology: Improve early diagnosis of common childhood cancers and treatment completion
  • Primary health care: Build skills of professionals working at the primary health care level and to develop a scalable resource for C/Can cities
  • Rapid diagnostic pathways: Improve capacity and develop a model for rapid diagnostic pathways
  • TeleEcho for pathology: Guided practice and ongoing mentoring in good practices  in pathology laboratory manuals
  • TeleEcho for imaging: Enhancing knowledge, skills and expertise in imaging

Learn more about C/Can’s project portfolio here


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