Programa de Acción Específico Cáncer en la Infancia y la Adolescencia 2013–2018

Objectives

Mexico’s 2013–2018 Specific Action Programme on Cancer in Childhood and Adolescence aims to reduce mortality and improve quality of life for people under 18 with cancer and their families, principally by favouring early diagnosis and timely, universal, comprehensive, high-quality and free treatment.[1][2][3][4][5]It forms part of the Sectoral Health Programme and aligns with the National Development Plan goal of an Inclusive Mexico, including effective access to health services, health protection, promotion and prevention.[6][3][4]

• Address childhood and adolescent cancer as a major public-health concern, including its status as a leading disease-related cause of death among children aged 5 to 14, with around 5,000 new cases and more than 2,000 deaths annually reported in Mexico.[7][8][9][5]
• Reduce late presentation, as approximately three quarters of cases are diagnosed at advanced stages, which lowers cure prospects and increases treatment duration, complexity and cost.[1][8][9][5]
• Strengthen prevention, surveillance, diagnosis, treatment and follow-up, while reducing inequalities and improving survival for children and adolescents with cancer.[7]
• Promote early recognition, prompt referral and effective service access, alongside timely and integrated treatment delivered through specialist networks.[1][3][4]
• Train health personnel, reduce treatment abandonment, maintain a reliable and complete cancer register, and use mass communication to increase public awareness.[3]
• Develop a national care model, strengthen programme stewardship and State Councils for the Prevention and Treatment of Childhood and Adolescent Cancer, improve health-worker competencies, and use epidemiological information for decision-making.[5][10]
• Support comprehensive care during prolonged hospital stays through the Sigamos Aprendiendo en el Hospital initiative, combining educational and cultural support with clinical care to limit educational delay and improve quality of life.[11][12]
• Promote primary prevention through vaccination, healthy eating, physical activity, avoidance of tobacco and alcohol, ultraviolet protection and safer sexual practices, while recognising that the programme’s principal operational emphasis is secondary prevention through early detection and treatment.[2][13][3]

Implementation

Implementation combines national stewardship, coordination across the National Health System and federal entities, specialist referral networks, information-system strengthening, and engagement with civil society.[14][7][9][10]The programme uses strategies, lines of action, indicators and targets to support delivery, monitoring and evaluation, within a human-rights, gender and intercultural framework.[15][7]

• Coordinate delivery through the National Council for the Prevention and Treatment of Cancer in Children and Adolescents, known as CONACIA, established by the Federal Government and organised civil society to support early detection and timely treatment.[1][9]
• Link the Childhood and Adolescent Cancer Programme with the Undersecretariat for Prevention and Health Promotion, General Health Council, Economic Analysis Unit, National Commission for Social Protection in Health, Fund for Protection against Catastrophic Expenditure, and directorates responsible for planning, quality, education and epidemiology.[9][16]
• Operate a service network in which first-contact personnel identify suspected cancer and promptly refer patients to accredited medical units or specialised referral units with suitable staff and infrastructure.[1]There were 64 accredited medical units reported as providing cancer care to people under 18.[7]
• Apply standardised clinical criteria and protocols for haematological cancers, central nervous system tumours, other solid tumours and haematopoietic progenitor-cell transplantation, supported by Clinical Practice Guidelines and technical care protocols.[16][17]
• Build workforce capacity through training for doctors, nurses and other personnel in cancer recognition, prevention, early diagnosis, treatment and timely referral.[17][5]The reported specialist workforce of approximately 165 paediatric oncologists, 35 paediatric haematologists, 35 paediatric surgical oncologists, 10 paediatric radiotherapists and 5 paediatric psycho-oncologists was considered insufficient for demand.[1]
• Coordinate national and state health authorities, social-security institutions, the Secretariats of National Defence and the Navy, the National System for Integral Family Development, universities, hospitals and civil-society organisations.[10][18][19][20]The COECIA network recorded 225 health-sector institutions across 31 federal entities as of November 2014.[20]
• Strengthen the Childhood and Adolescent Cancer Registry and link it with health, financing and mortality information systems, including the National Health Information System and the Statistical Epidemiological System of Deaths, to track cases and generate internationally comparable information.[11][9]
• Monitor annually the proportion of relevant National Health System units that register cases with quality in the Cancer Registry, with targets rising from 40% in 2014 to 80% in 2018.[21]A quality record requires at least 80% compliance with specified criteria, including non-duplication, oncologist validation, complete mandatory information and recent follow-up.[12]
• Monitor annual sectoral participation in State Councils, with targets rising from 45% in 2014 to 70% in 2018, and publish programme progress through health-sector websites to support transparency, accountability and budgetary decision-making.[21][22]
• Finance eligible paediatric oncology treatment through the Fund for Protection against Catastrophic Expenditure and Seguro Popular, which from 2011 covered 85% of childhood cancer cases among people without social security.[9]No overall programme budget, unit costs, funding gap or resource-mobilisation target is specified in the supplied material.[22]

Monitoring & Evaluation

The programme establishes a monitoring and accountability approach centred on cancer registration, epidemiological and mortality information, annual performance indicators, state-level coordination, and public reporting. Its principal measurable objective is to support early diagnosis and timely, universal treatment for children and adolescents with cancer.[3][4][21]

• Maintain a reliable and complete Childhood and Adolescent Cancer Registry, linking cancer information with the National Health Information System, the Statistical Epidemiological System of Deaths, health-protection systems and other administrative data to follow patients and inform decisions.[11][3][18]
• Strengthen epidemiological surveillance and analyse registry information continuously to assess the cancer situation, identify changing epidemiological patterns, and adapt interventions.[15][11][5]
• Monitor annually the proportion of National Health System paediatric cancer units that register cases with quality in the Childhood and Adolescent Cancer Registry.[21]Quality registration requires fulfilment of at least 80% of defined criteria, including non-duplicated cases, oncologist validation, complete International Classification of Childhood Cancer data and mandatory fields, recording of funded cases where applicable, and complete follow-up during the preceding six months.[12]
• Increase the registry-quality indicator from 40% in 2014 to 50% in 2015, 60% in 2016, 70% in 2017 and 80% in 2018, which is also the six-year target.[21]
• Monitor annually the sectoral functioning of State Councils for the Prevention and Treatment of Childhood and Adolescent Cancer, measured as participating health-sector institutions relative to institutions present in each federal entity.[21]Raise this measure from 45% in 2014 to 51% in 2015, 57% in 2016, 63% in 2017 and 70% in 2018, with a six-year target of 70%.[21]
• Use the Childhood and Adolescent Cancer Registry, the Integrated System of Human Resources, Infrastructure and Equipment for Health, the Unique Health Establishments Catalogue and activity reports as information sources.[21]The Directorate-General of Epidemiology administers the registry platform, while the National Centre for Child and Adolescent Health and state health services provide reference and oversight functions.[21]
• Evaluate programme compliance with applicable regulations, verify the operation of State Councils, and assess and strengthen the Sigamos Aprendiendo en el Hospital strategy across all 32 federal entities.[5][12][10]
• Publish progress information through the websites of the Secretariat of Health, the Undersecretariat for Prevention and Health Promotion, and the National Centre for Child and Adolescent Health, supporting transparency, public accountability, performance management and budgetary decision-making.[22]

Reported evidence highlights substantial need and service-performance challenges: approximately 75% of patients under 18 are diagnosed at advanced stages, estimated five-year overall survival in accredited units is 56%, and treatment abandonment fell from 30% in 2006 to 7% in 2012.[1][8][9]Between 2007 and 2012, 13,195 cases were diagnosed and financed through the catastrophic-expenses fund, while acute lymphoblastic leukaemia accounted for 5,537 cases, or 41.9% of the total.[17][23]Mortality and registry data draw on sources including the Directorate-General for Health Information, preliminary death-statistics data, the National Population Council and the National Institute of Statistics and Geography.[24][25]The available material does not specify audit procedures, a comprehensive evaluation methodology, reporting timetables, or named sanctions for non-performance.[7][4]

Costing & Financing

Financing for childhood and adolescent cancer treatment is principally linked to Mexico’s financial-protection arrangements, particularly the Fund for Protection against Catastrophic Expenditure, while the supplied material provides no monetary programme budget, unit costs, funding-gap estimate or resource-mobilisation target.[9][17][22]

• Finance paediatric oncology treatment through the Fund for Protection against Catastrophic Expenditure, which classified treatment as catastrophic because complex or specialised care and medicines involve high costs.[9]Accredited medical units are defined as units with cases financed through this fund.[18]
• Record 54 of 64 accredited medical units as reporting cases financed through the Fund for Protection against Catastrophic Expenses.[7]
• Expand financial coverage in stages, beginning with acute lymphoblastic leukaemia in 2007, approving ten protocols in 2008, and extending coverage to all malignant conditions affecting people under 18 following the “All children, all cancers” initiative.[17]
• Finance 85% of childhood cancer cases among people without social security through Seguro Popular from 2011, after expansion of the benefit catalogue to all cancer types affecting people under 18.[9]
• Report 13,195 diagnosed cases financed through the catastrophic-expenses fund between 2007 and 2012, with financed cases increasing by 69.9% during that period.[17]
• Supplement federal and state financing through organised civil-society support where patients’ care needs are not covered by public financing programmes.[9]
• Recognise advanced diagnosis as a cost driver because it requires longer, more sophisticated and less effective treatment, while reducing the probability of cure.[1][8][9]
• Address workforce constraints, as the available specialist workforce includes approximately 165 paediatric oncologists, 35 paediatric haematologists, 35 paediatric surgical oncologists, 10 paediatric radiotherapists and 5 paediatric psycho-oncologists, and is considered insufficient for demand.[1]

The material refers generally to effective use of health resources and identifies specialised-care infrastructure, training, registry systems and accredited units as resource requirements, but it does not quantify their costs or allocations.[26][17][5]It also does not provide total expenditure, currency-denominated financing, annual appropriations, cost-effectiveness assumptions, donor funding, or a formal estimate of unmet financing needs.[7][2][22]