Table 5

Components of cancer health services
Component Factors
Effective leadership and governance committed to health equity through sound public health policies and effective and accountable governance Responsible for national cancer healthcare policies, plans and strategies and their implementation by effective governance of financing, infrastructure, human resources, drugs, technology and service delivery with relevant guidelines, plans and targets
Adequate financing of health services (health financing) to develop optimal healthcare infrastructure, recruitment and retention of human resources and to ensure universal health coverage by removing financial barriers to access and by preventing financial hardship and out-of-pocket catastrophic expenditure Government budget lines, a system to raise and pool donor funds fairly
Social security and employee insurance schemes and cost recovery mechanisms
A financing governance system supported by relevant legislation, auditing and public expenditure reviews and clear operational rules to ensure timely and efficient use of funds
Adequate human resources for healthcare administration and delivery Investing in and improving education through academic initiatives
Recruitment, distribution, and retention by appropriate payment systems with right incentives
Enhancing productivity, performance, competency and skills by in-service training, reorientation, continuing education opportunities, establishment of job-related norms, support systems, enabling work environments and job promotion opportunities
Ensuring universal access to essential diagnostics, vaccines, drugs and technologies National lists of essential medical products, national diagnostic and treatment protocols, and standardised equipment per levels of care to guide procurement, to promote rational prescription and reimbursement
A supply and distribution system to ensure universal access to essential medical products and health technologies through public and private channels, with focus on the poor and disadvantaged
A medical products regulatory system for marketing authorisation, quality assurance and price and safety monitoring, supported by relevant legislation and enforcement mechanisms
Service delivery through a network of primary, secondary and tertiary care networks Preventive services (health education, awareness, control of tobacco/alcohol/other cancer risk factors, healthy diet, promotion of physical activity, obesity/overweight control, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination)
Early detection services (population awareness on early symptoms/signs, improving early detection skills of primary care practitioners by in-service training and reorientation, screening, early diagnosis, development of referral pathways)
Diagnosis and staging (histopathology, cytology, haematology, immunohistochemistry, tumour markers, biochemistry, microbiology, x-ray, magnetic, ultrasound and nuclear imaging and endoscopy services)
Treatment services (cancer surgery, radiotherapy, chemotherapy, hormone therapy targeted therapy, bone marrow transplantation, rehabilitation and counselling services), palliative care (oral morphine, other opioids and analgesics, adjuvant drugs, symptomatic treatments)
Systems and establishments to render the above services (comprehensive cancer centres, specialised centralised services such as paediatric oncology services, oncology units in district and provincial hospitals, community cancer centres, cancer screening units, rural extension services for follow-up care in remote areas, palliative care units, palliative care teams, home care and community palliative care networks)
Health information initiatives and systems such as risk factor surveys, population based cancer registries, hospital cancer registries, medical records departments, screening programme and health insurance databases and death registers To quantify cancer burden to facilitate planning cancer services
To evaluate effectiveness of cancer control activities by monitoring trends in risk factor prevalence, trends in cancer incidence, stage distribution, survival and mortality

Adapted from World Health Organization key components of well functioning health systems (http://www.who.int/healthsystems/EN_HSSkeycomponents.pdf webcite) and World Health Organization [18].

Sankaranarayanan et al.

Sankaranarayanan et al. BMC Medicine 2014 12:3   doi:10.1186/1741-7015-12-3

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