The future of cancer care: health system sustainability in the Middle East and North Africa (MENA)

Thefutureofcancercare:healthsystemsustainabilityintheMiddleEastandNorthAfrica(MENA) Supportedby Contents 3Aboutthisreport 4Executivesummary 6Introduction Theroleofhealthsystemsustainabilityinoncology 11HealthsystemServicedeliveryHealthworkforceInfrastructure 19HealthfinancingAffordabilityPricecontrolHealthbudgetValueassessment 26Governance Policy Multi-stakeholdercollaboration 30Innovation&data RegistriesClinicaltrialsDigitalhealth 35Conclusion 37References 41Appendix1:Countrysnapshots EgyptLebanonUAE Aboutthisreport Thefutureofcancercare:healthsystemsustainabilityintheMiddleEastandNorthAfrica(MENA)isanEconomistImpactwhitepaper,commissionedbyBeiGene.ThereportprovidesanindependentanalysisofthegrowingcancerburdenintheMENAregionandthechallengesthispresentstothesustainabilityofoncologycareandthewiderhealthsystem.Itfurtheraimstounderstandthelimitingfactorsforsustainabilityincancercareandidentifypotentialwaystoclosethegapsacrossthepatientpathway.Thereportwasdevelopedbasedonanextensiveliteraturereviewandin-depthinterviewswithrelevantclinicalexperts,scientificleaders,policystakeholdersandpatientadvocates.TheeditorialteamatEconomistImpactwouldliketothankthefollowingindividuals(listedalphabetically)forgenerouslycontributingtheirtimeandinsights,whichhavebeencriticaltothecreationofthisreport: DrAhmedSeyam,Director,HealthEconomics&HealthSystemsResearch,UniversalHealthInsuranceAuthority,Egypt MrImadElHajje,PublicRelations&ExternalAffairsTeamLeader,Children’sCancerCenterofLebanon(CCCL) DrLamiaMahmoud,RegionalAdviser,NoncommunicableDiseasesPrevention(NCP)Programme,DepartmentofNoncommunicableDiseasesandMentalHealth,RegionalOfficefortheEasternMediterranean,WorldHealthOrganization MrMajedMohamedIbrahim,HeadofAdvocacy&ScientificAffairs,FriendsofCancerPatients(FoCP),UnitedArabEmirates DrMarwanGhosn,Chairman,Haematology –OncologyDepartment,FacultyofMedicineSaint-JosephUniversity,Lebanon DrMohsenMokhtar,Professor,ClinicalOncology,CairoUniversity;ManagingDirector,CairoUniversity’sCenterofOncologyandNuclearMedicine(NEMROCK);President,CanSurvive,Egypt ThereportfocusesonselectedcountriesintheMiddleEastandNorthAfrica(MENA)region;Bahrain,Kuwait,Oman,Qatar,SaudiArabia,UnitedArabEmirates(UAE),Iraq,Jordan,Lebanon,Egypt,SyriaArabRepublicandYemen,providingarepresentativesampleintermsofpopulationsizeandincomegroupsintheregion.ThereportalsoreferstotheWHORegionalOfficefortheEasternMediterranean(WHOEMR),whichcovers22countriesandterritoriesinWestAsia,NorthAfrica,theHornofAfricaandCentralAsia. EconomistImpactbearssoleresponsibilityforthecontentofthisreport.Thefindingsandviewsexpressedinthereportdonotnecessarilyreflectthesponsor’sviews.TheresearchwasledbyClareRoche,withresearchandwritingconductedbyClareRoche,GerardDunleavy,GiuliaGarcia,AlcirSantosNetoandVitorTairaYi.Whileeveryefforthasbeenmadetoverifytheaccuracyofthisinformation,EconomistImpactcannotacceptanyresponsibilityorliabilityforreliancebyanypersononthisreportoranyoftheinformation,opinionsorconclusionssetoutinthisreport. Executivesummary Cancer,aleadingcauseofdeathworldwide,currentlycontributestomorethanoneineverysixdeathsglobally.1Thehealthandeconomicburdenposedbycancerissettoincrease,withtheWorldHealthOrganization(WHO)projectingthatcancerincidencewillincreaseby50%by2040incomparisonto2020levels.2TheMiddleEastandNorthAfrica(MENA)regionisonthecuspofademographictransitionthatwillsignificantlyimpacttheburdenofcanceroverthenexttwotothreedecades.Theelderlypopulation(aged>65years)willincreaseby290%between2018 and2050,from28min2023to92min2050.3 Asaresultofthegrowingandageingpopulations,thenumberofnewlydiagnosedcancersandcancerdeathsintheWHOEasternMediterraneanRegion(EMR)isexpectedtodoubleby2040.TheincidenceofcancerinIraq,SaudiArabiaandSyria,forinstance,isprojectedtoincreasebymorethan100%,whileintheUnitedArabEmirates(UAE),itisprojectedtoincreasebyasmuchas231%.4 Therisingburdenofcancerwillforcecountriestoinnovate,rethinkstrategy,andre-prioritiseresourcestoensurethathealthsystemscandelivercancercarethatisbothhigh-qualityandsustainable.ThediversityoftheMENAregionintermsofpopulationsizeanddensity,as wellaseconomicandpoliticalsystemsmeansthattheprovisionof,andaccessto,qualitycancercarevarygreatlyacrosstheregion. Despitethisheterogeneity,healthcarepolicymakersandprovidersintheregionhavemanychallengesincommon.Theseincludeincreasingpressureonhealthservicesduetogrowingdemandsanddemographicchange,arisingburdenofchronicdiseases,andashortageofhealthcareworkers. Addressinginefficienciestodayiscriticaltosafeguardingthequalityofcancercareandtoallowinghealthsystemstoadapttothegrowingcancerburdensuchthattheyevolveforthebenefitofpatientsandsociety.Anumber ofcommonintegratedpolicyprioritiesandinterventionshavebeenidentifiedinthisreportthatwillhelpcountriesimproveaccessandhealthoutcomesinasustainablemanner. Scale-uppreventionmeasures–Cancercontrolstartswithprevention.Preventionincludesraisingawarenessofcancer,itssignsandsymptoms,andmeasurestotargetmodifiableriskfactors,suchastobaccouse, physicalinactivity,andunheal