Political priority and pathways to scale-up of childhood cancer care in five nations

BackgroundDespite increasing global attention to non-communicable diseases (NCDs) and their incorporation into universal health coverage (UHC), the factors that determine whether and how NCDs are prioritized in national health agendas and integrated into health systems remain poorly understood. Childhood cancer is a leading non-communicable cause of death in children aged 0–14 years worldwide. We investigated the political, social, and economic factors that influence health system priority-setting on childhood cancer care in a range of low- and middle-income countries (LMIC).Methods and findingsBased on in-depth qualitative case studies, we analyzed the determinants of priority-setting for childhood cancer care in El Salvador, Guatemala, Ghana, India, and the Philippines using a conceptual framework that considers four principal influences on political prioritization: political contexts, actor power, ideas, and issue characteristics. Data for the analysis derived from in-depth interviews (n = 68) with key informants involved in or impacted by childhood cancer policies and programs in participating countries, supplemented by published academic literature and available policy documents.Political priority for childhood cancer varies widely across the countries studied and is most influenced by political context and actor power dynamics. Ghana has placed relatively little national priority on childhood cancer, largely due to competing priorities and a lack of cohesion among stakeholders. In both El Salvador and Guatemala, actor power has played a central role in generating national priority for childhood cancer, where well-organized and -resourced civil society organizations have disrupted legacies of fragmented governance and financing to create priority for childhood cancer care. In India, the role of a uniquely empowered private actor was instrumental in creating political priority and establishing sustained channels of financing for childhood cancer care. In the Philippines, the childhood cancer community has capitalized on a window of opportunity to expand access and reduce disparities in childhood cancer care through the political prioritization of UHC and NCDs in current health system reforms.ConclusionsThe importance of key health system actors in determining the relative political priority for childhood cancer in the countries studied points to actor power as a critical enabler of prioritization in other LMIC. Responsiveness to political contexts–in particular, rhetorical and policy priority placed on NCDs and UHC–will be crucial to efforts to place childhood cancer firmly on national health agendas. National governments must be convinced of the potential for foundational health system strengthening through attention to childhood cancer care, and the presence and capability of networked actors primed to amplify public sector investments and catalyze change on the ground.研究背景 尽管全球对非传染性疾病（non-communicable diseases, NCDs）的关注度不断提升，且其已被纳入全民健康覆盖（universal health coverage, UHC）体系，但目前学界对“哪些因素决定非传染性疾病能否以及如何被纳入国家卫生议程并整合进卫生系统”这一问题仍知之甚少。儿童癌症是全球0~14岁儿童非传染性死亡的首要诱因。本研究针对多家中低收入国家（low- and middle-income countries, LMIC），探究了影响儿童癌症诊疗卫生系统优先级设定的政治、社会与经济因素。 研究方法与结果 本研究基于深度定性案例研究，采用涵盖政治优先级四大核心影响维度——政治环境、行动者权力、理念与议题特征——的概念分析框架，对萨尔瓦多、危地马拉、加纳、印度及菲律宾的儿童癌症诊疗优先级设定决定因素展开分析。研究数据来源于对参与国中涉及或受儿童癌症政策与项目影响的关键知情人开展的68次深度访谈，同时辅以已发表的学术文献与可获取的官方政策文件。 各国对儿童癌症的政治优先级设置差异显著，且主要受政治环境与行动者权力动态的影响。加纳对儿童癌症的国家优先级相对较低，主要源于存在其他竞争优先级的卫生议题，且国内利益相关方缺乏凝聚力。在萨尔瓦多与危地马拉，行动者权力是推动儿童癌症国家优先级确立的核心驱动力：组织完善、资源充足的民间社会组织打破了治理与筹资碎片化的历史遗留问题，为儿童癌症诊疗确立了政策优先级。在印度，一位获得独特授权的私营行动者发挥了关键作用，不仅助力确立了儿童癌症诊疗的政治优先级，还建立了可持续的儿童癌症诊疗筹资渠道。在菲律宾，儿童癌症社群借助当前卫生系统改革中将全民健康覆盖与非传染性疾病列为政治优先级的机遇窗口，扩大了儿童癌症诊疗的可及性并缩小了诊疗公平差距。 研究结论 本研究涉及国家的案例表明，关键卫生系统行动者对儿童癌症政治相对优先级的确定起着决定性作用，这意味着行动者权力是其他中低收入国家推动儿童癌症优先级确立的关键促成因素。对政治环境的响应——尤其是针对非传染性疾病与全民健康覆盖的政策宣传与政策优先级设置——对将儿童癌症切实纳入国家卫生议程至关重要。各国政府需充分认识到，关注儿童癌症诊疗可有效强化卫生系统的基础能力；同时，需培育具备联动能力的行动者网络，以助力扩大公共部门投入并推动实地层面的变革。