In April 2015, an international cancer control assessment was conducted in El Salvador to support the country's efforts to fight cancer. The assessment called the 'integrated mission of PACT' (imPACT) was conducted following a request from the Ministry of Health of El Salvador. A team of cancer control experts participated in the imPACT mission coordinated through the International Atomic Energy Agency's flagship health initiative, the Programme of Action for Cancer Therapy (PACT).
imPACT assessments comprise of highly experienced specialists in cancer registration and information, prevention, early detection, diagnosis, treatment, palliative care and radiation safety. PACT works closely with its partners from the World Health Organization/Pan American Health Organization (WHO/PAHO) and the International Agency for Research on Cancer (IARC) to ensure a complete picture of El Salvador's response to fighting cancer can be analysed.
The imPACT team visited health facilities at different levels of care and conducted extensive discussions with the major national cancer control stakeholders, including private sector and non-governmental organisations.
The Vice Minister of Health, Dr Julio Robles Ticas, warmly thanked the imPACT team for their timely support during the Ministry's development of a strategy, which will guide the implementation of the National Policy for Cancer Prevention and Control. This national policy was recently developed by a multi-stakeholder committee appointed by the Ministry of Health representing all health providers in El Salvador with the technical support from the WHO/PAHO country office. According to Dr Julio Robles Ticas, "the policy is expected to provide the framework for effective coordination among all stakeholders involved in the provision of cancer care to patients in El Salvador". The Vice Minister of Health also mentioned that "efforts are being taken to develop a national cancer registry in the country to assist in the planning and effective allocation of resources for cancer". The WHO/PAHO country office have been working with the Ministry of Health to review the national hospital cancer patient admissions since 2009.
To lead the process of implementing the policy, the Ministry of Health recently created a National Cancer Unit (NCU). Dr Andrea Chacon, Head of NCU and imPACT focal point said, "the mission's findings and recommendations will provide valuable inputs for El Salvador in developing the national cancer strategy". She added, "the mission report will hopefully aid future collaboration with IAEA, PAHO and other development partners".
The country's public health system provides full coverage of its services to approximately 80% of the population and is composed of three national hospitals for referral of cancer patients (Benjamin Bloom, Nacional de la Mujer and Rosales). Other health providers include the Salvadorian Institutes of Social Security and Magisterial Welfare, the Army Medical Command, NGOs and private institutions. Cancer treatments currently offered at the national hospitals are limited to chemotherapy, hormonal therapy, oncology surgery and palliative care. At present, the existing model does not allow for the increasing demand for radiotherapy in the country. Patients requiring this treatment are presently referred to other hospitals such as the Specialized Oncology Hospital of the Salvadorian Social Security Institute and the Institute of Cancer of El Salvador. This consequently leads to long waiting times to commence radiotherapy as well as more radical surgeries instead of less invasive medical procedures. Additionally, the public is still liable for out of pocket expenses at institutions outside the public health system. This only adds to the impoverishment of cancer patients and their families.
In the light of this, the Ministry of Health is committed to strengthen the referral systems and establish a radiotherapy department integrated within the public health system to ensure greater access to effective cancer treatment to the population of El Salvador. The creation of a national radiotherapy centre will be aligned and integrated within a broader national cancer control strategy.
PACT's mission is to fight cancer in low and middle income countries by ensuring effective partnerships and integrating radiation medicine within a comprehensive national cancer control approach.