Eliminating Inequities in Childhood Cancer Care : Dr Syed Ali Shazif Baqari

Inequities in childhood cancer care in Pakistan stem from a complex interplay of various factors. These disparities can be attributed to:
Limited Access to Healthcare:
Rural population constitute 62% of total population of Pakistan. Rural areas lack adequate healthcare infrastructure and online referral system, leading to limited access to specialized childhood cancer care.
Financial Barriers:
According to Oxfam poverty report, the top 1% of households in Pakistan hold 21.9% of the country’s wealth, while the bottom 50% of households hold just 4.4%. Many families in Pakistan face financial constraints and cannot afford the high costs associated with cancer treatment, including diagnosis and staging of cancer, chemotherapy, surgeries, radiotherapy and hospitalization.
Geographic Disparities:
Paediatric cancer centers are primarily concentrated in urban areas, leaving children in rural and remote regions with reduced access to care. Balochistan, which forms 43% of the total area of Pakistan, has no comprehensive paediatric oncology center.
Healthcare Workforce Shortages:
There is a shortage of paediatric oncologists, nurses, and support staff even in urban areas like Lahore and Karachi.
Lack of Awareness:
Low awareness levels about childhood cancer symptoms, early detection, and available treatments can result in delayed diagnosis and treatment.
Stigma and Cultural Beliefs:
Cultural beliefs and misconceptions about cancer lead to stigma, causing families to delay seeking medical help or opting for traditional remedies initially.
Inequitable Distribution of Resources:
Limited resources and funding for pediatric oncology within the healthcare system has led to disparities in the quality and availability of care.
Transportation Challenges:
Poor transportation infrastructure in rural areas makes it difficult for families to travel long distances to access cancer treatment centers.
Language and Literacy Barriers:
Language differences and low literacy rates in remote and rural regions hinder communication between healthcare providers and patients, affecting treatment comprehension and adherence.
Limited Research and Data:
Insufficient local research on childhood cancer and its causes in Pakistan hinder the development of tailored early detection and treatment strategies.
Political and Economic Factors:
Political instability and economic challenges divert resources away from healthcare, exacerbating inequalities in childhood cancer care. The Federal Budget 2023 was passed on 9th June and the health sector was allocated just PKR 24.25 billion making up 2.8 per cent of the total development budget and 0.05 per cent of GDP.
Public Policy and Regulation:
Inadequate policies, regulations, and enforcement mechanisms lead to disparities in access to cancer care services and quality standards.
Lack of Legislation
Health is not a fundamental right of all citizens according to the constitution of Pakistan.

Addressing these inequalities requires a multifaceted approach, involving increased investment in healthcare infrastructure, education, awareness campaigns, and policy reforms. Collaboration between government agencies, non-profit organizations, healthcare providers, and the community is essential to mitigate these disparities and ensure that all children in Pakistan have equitable access to cancer care.

Eliminating the inequalities in childhood cancer care in Pakistan is a complex and long-term endeavor that requires concerted efforts from various stakeholders. Here are strategies to address and eventually eliminate these disparities:
Expand Healthcare Infrastructure:
Build and upgrade pediatric oncology centers in underserved areas and develop online referral system ensuring geographic equity in access to cancer care.
Financial Support:
Establish financial assistance programs or insurance schemes to alleviate the burden of treatment costs on families.
Health Workforce Development:
Invest in training and recruiting more pediatric oncologists, nurses, and support staff, with incentives for those willing to work in rural or remote regions.
Awareness and Education:
Conduct nationwide awareness campaigns to educate the public, healthcare providers, and educators about childhood cancer symptoms, early detection, and treatment options. Childhood cancer education should be included in the syllabus of all schools and “madaris”.
Community Engagement:
Involve community leaders and volunteers in awareness programs and support services to address cultural beliefs and stigma.
Telemedicine and Mobile Clinics:
Implement telemedicine services and mobile clinics to bring cancer care closer to remote communities, facilitating early diagnosis and treatment. Follow AKU Karachi and IHHN models.
Research and Data Collection:
Promote local research on childhood cancer to better understand its causes and risk factors in Pakistan, allowing for tailored early detection strategies.
Policy Reforms:
Advocate for policy changes that prioritize childhood cancer care, allocate resources, and establish quality standards for treatment and care facilities.
Public-Private Partnerships:
Collaborate with private healthcare providers and non-profit organizations to expand access to cancer care and treatment options. All the private and public sector hospitals should be centralized.
Transportation Assistance:
Address transportation challenges by providing transportation subsidies or services to help families reach treatment centers.
Multilingual and Culturally Sensitive Care:
Train healthcare providers in effective communication, ensuring that language and cultural differences do not hinder patient understanding and adherence.
Monitoring and Evaluation:
Establish a system to monitor progress in reducing disparities and evaluate the effectiveness of programs, making adjustments as needed.
International Collaboration:
Collaborate with international organizations to access expertise, resources, and best practices in childhood cancer care.
Legislation and Regulation:
Advocate for and enforce legislation and regulations that protect the rights and well-being of children with cancer, ensuring access to quality care. Lawmakers should bring constitutional amendments to introduce childhood cancer care as a fundamental right of every child diagnosed with cancer.
Inclusive Research and Decision-Making:
Involve local communities, healthcare professionals, and families of affected children in decision-making processes and research initiatives.
Eliminating inequalities in childhood cancer care in Pakistan is a long-term commitment that requires sustained funding, collaboration, and advocacy. By addressing the root causes and implementing these strategies, progress can be made toward ensuring that every child in Pakistan, regardless of their background or location, has equitable access to quality cancer care and a chance at a healthier future.