Page 0044

The imPACT Review is a unique tool to deliver a

comprehensive analysis of a country's capacity in cancer

control, with multidisciplinary expertise in the areas of

cancer control planning, cancer registration and

information, prevention, early detection, diagnosis,

treatment, palliative care, radiation safety and civil society's

role in cancer control.

The imPACT Reviews are truly multi-stakeholder as well

as multi-disciplinary missions. To date, IARC has been

involved in more than 60% of all imPACT Review Missions

and WHO (at regional and country levels) in more than 80%.

While the IAEA provides expertise in radiation diagnostics,

nuclear medicine, radiotherapy and radiation safety, the

WHO and IARC nominate experts to cover the areas of

cancer control planning, prevention, early detection and

palliative care. Regional expertise is favoured to enable

exchange of practical knowledge among professionals from

similar resource settings and to promote linkages and

potential partnerships between regional institutions. Other

partners in this effort have included UICC and the United

States National Cancer Institute (US-NCI), among others.

The missions are undertaken at the request of the

Minister of Health and provide the Minister of Health with

recommendations for strengthening a national cancer

control programme. The mission's findings and

recommendations of this joint needs-assessment assist

countries, the IAEA, partners and potential donors to

identify areas of support and specific projects to respond to

these needs in an effective and coordinated manner. Within

six months of receiving the imPACT Report, an official

response from the Ministry of Health to the IAEA is usually

received, endorsing the recommendations and/or

requesting additional support for follow-up actions based on

the mission's findings. The IAEA seeks to ensure that

investments in radiation medicine are integrated within a

comprehensive cancer control approach. Findings and

recommendations of the imPACT Reviews inform future

cancer-related technical cooperation projects.

Since the creation of PACT, national cancer control

capacities and needs have been assessed in 70 countries

through an imPACT Review (Fig. 1). Out of those, five

countries received a preparatory PACT mission to cover a

specific area(s) of the cancer control continuum. These

missions are generally composed of an expert or a small

expert team intended to support the national counterparts

in the preparation for the imPACT Review. The imPACT

Review expert team is usually composed of five medical and

public health specialists covering different areas of cancer

control. As of 2015 PACT is starting to offer an imPACT

Phase II Review to the countries which had an imPACT

Review more than five years ago. The goal of the imPACT

Phase II Review is to assess progress made since the first

mission as well as to look at capacities and needs, especially

in geographical areas which were not part of the original

assessment.

Increasing human resources for cancer control

As is widely recognized, a critical barrier to providing cancer

care in LMICs is the profound shortage of health

professionals. According to WHO, 57 countries worldwide

are experiencing a critical shortage of health professionals,

including 36 in sub-Saharan Africa. In order to achieve

sustainable cancer control capacity in developing countries,

and in Africa in particular, it has been recognized there must

be a dramatic surge in the number of professionals trained

locally or regionally across the various areas of cancer

control. Additionally, measures must be put in place to

strengthen local recruitment and ensure retention of

graduates from national training programmes.

Local capacities to train and mentor practitioners across

many regions in Africa, Asia, Latin America and Europe are

largely insufficient to ensure the implementation of

sustainable cancer control programmes and counter the

effects of medical migration, otherwise known as "braindrain".

Combined with a lack of financial resources, the

dearth of training opportunities has resulted in a deficiency

of trained professionals in health care, which is often

particularly acute in cancer diagnosis and treatment. This

has significant implications for cancer patients requiring

care in many LMICs, where oncology services are scarce or

completely unavailable.

To address LMICs' cancer workforce shortage, PACT

launched an initiative in 2010 to establish a Virtual

University for Cancer Control (VUCCnet). Established in

collaboration with WHO, IARC, UICC, US-NCI and the

African Organisation for Research and Training in Cancer

(AORTIC), the project seeks to support and enhance national

programmes to build human resource capacity in cancer

control. VUCCnet is building a web-based, e-learning

platform to make educational materials more easily

accessible for trainees; and is further aiming to establish

training and mentorship networks.

In the pilot phase of the project, Ghana, Uganda, United

Republic of Tanzania and Zambia comprise the initial cadre

of first-phase countries. The Republic of South Africa and

Egypt have agreed to operate as mentor countries to the

project, as both have considerable educational capacity and

can provide access to institutions focused on training cancer

CANCER MANAGEMENT

42 CANCER CONTROL 2015

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