Breast and cervical cancer screening in Tacloban City
The Philippines is a lower middle income country (LMIC) with a population of 111 M.1 It has a fragmented healthcare system divided into public and private, and primary to tertiary levels of care with a relatively unclear referral system.Patients have their choice of doctors to go to but understandably, will have difficulty deciphering which specialties to consult with or services to avail. There is limited government support for healthcare 2 with no coverage for out-patient care.
Compounding this situation is the low health literacy of the country especially when it comes to healthcare. In a study published by The Economist in 2020, the Philippines was 10th in 10 countries evaluated in Asia-Pacific when it comes to being prepared to manage the burden of cancer.3 In 2019, after much advocacy, the country passed two landmark laws : the National Integrated Cancer Control Act and the Universal Healthcare Law, both in various stages of implementation.4
Some of the biggest challenges a cancer patient faces in the Philippines are the difficulty of navigating his/ her way through the healthcare system to access the right services in a timely manner, overcoming the biases of being diagnosed with a “fatal disease”, and finding funding sources to help support diagnostics and treatment. With breast cancer being the first and cervical cancer being the 6th in cancer prevalence in the Philippines 5,the goal of 2030 Mission Leapfrog in the Philippines is to build towards a fully-financed referral system, including diagnosis and treatment, initially focusing on breast and cervical cancer. We want the Filipino woman to be telling a different cancer story prior to and at the end of the project.
The project is composed of 4 components : (1) Mobilization and education (2) Screening, Diagnosis, and Treatment, (3) Funding, and (4) Institutionalization.
1. Mobilization and education – We are working with the Department of Education of Tacloban City to mobilize their women teachers to be educated about cancer to encourage them to proactively access screening, diagnosis or treatment as appropriate.
2. Screening, Diagnosis and Treatment from the local government health clinic to the tertiary referral hospital is done in coordination with Tacloban City Health Office and facilitated with the help of a digital tool called LIFE where teachers can teleconsult, be screened and receive ff up information.
3. Funding – With the help of local groups such as Tingog Partylist in Tacloban, we are pooling resources to find funding for each level of care.
4. Institutionalization – We are working with local policy-makers to ensure that commitment and identified solutions are supported by policies to ensure sustained commitment and support.
In its initial salvo, 200 personnel of Tacloban City were educated on cancer. Following this, 175 women were screened for risks for breast and cervical cancer, and 24 are referred to the tertiary hospital for confirmatory diagnosis with full funding support from Tingog Partylist. The activity was much appreciated by the local stakeholders with the Department of Education Superintendent for Tacloban City, Dr. Mariza Magan, saying that it answers a great need for teachers under their supervision who taught that cancer is a death sentence and who hesitate accessing health services due to fear of the cost and the fear of a “death sentence”.
The next goals are to reach the 1,700 women teachers of Tacloban City by the end of the year and to scale the project to cities in the National Capital Region of the Philippines. With continued success, we hope that this project contributes to the knowledge base towards integrating cancer services within the Universal Healthcare practice in the Philippines.
- Philippine Statistics Authority.https://psa.gov.ph/sites/default/files/attachments/hsd/pressrelease/Cities and Municipalities Population Projections_2015CBPP_Phils.pdf. Last accessed 21 September 2022.
- PhilHealth Annual Report 2019. https://www.philhealth.gov.ph/about_us/annual_report/ar2019.pdf. last accessed 21 September 2022.
- Tolabing MCC, Co KCD, Mendoza OM, Mira NRC, Quizon RR, Tempongko MSB, Mamangon MAM, Salido ITO, Chang PWS. Prevalence of Limited Health Literacy in the Philippines: First National Survey. Health Lit Res Pract. 2022 Apr;6(2):e104-e112. doi: 10.3928/24748307-20220419-01. Epub 2022 May 6. PMID: 35522857; PMCID: PMC9126056.
- The Economist. Cancer Preparedness in Asia Pacific 2020. https://worldcancerinitiative.economist.com/pdf/Roche-cancer-preparedness-in-asia/Roche_Cancer_White_paper.pdf
- WHO International Agency for Research on Cancer. https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf. Accessed 21 Sept 2022
Experts in the Philippines
Dr. Esperanza Cabral
Marco Antonio Valencia Sanchez
The goal of the Mission Leapfrog experiment in Thailand is to engage with ecosystem partners to improve health outcomes for the population of elderly women in urban environments that are at high risk for cancer but experience significant isolation and hardships. Our ambition is to harness technology to share clinical information across a network using telemedicine, so we can deliver better healthcare for this population. This ability to bring treatment options from the hospitals to the communities where these women live would be a leapfrog in impact for these women and healthcare delivery in the country overall.Read more