By Geraldine Arias de Goebl and Kendall Siewert, IAEA Department of Technical Cooperation
Earlier this spring, the IAEA and its partners adapted in-country expert assessments of national cancer control capacities and needs to a virtual format, so they could continue during the global COVID-19 pandemic. Moving online these assessments, known as imPACT reviews, ensured continuous support to national counterparts around the world despite travel restrictions.
“Adapting the imPACT Review modality with our partners was essential so that we could continue to support our Member States by providing them with a baseline situation analysis and a set of recommendations to guide cancer control planning and investments. Cancer doesn’t stop during a pandemic and neither can our support,” said IAEA Director of Programme of Action for Cancer Therapy (PACT), Lisa Stevens.
Rather than meeting face-to-face with stakeholders and conducting in-country site visits, the expert team uses a combination of virtual meetings, photos, recorded video and virtual live walk-throughs of health facilities. These virtual activities pave the way for necessary verification and high-level dialogue that will be carried out in-country once travel limitations are lifted.
Following requests from various governments, the IAEA, the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) have conducted imPACT Review missions since 2005. These reviews help national authorities improve their cancer control efforts and have been conducted mostly in low- and middle-income countries. imPACT Reviews support the development of national cancer control plans, help to formulate workforce development plans and aid the mobilization of funds for cancer services.
imPACT Reviews that a delivefred partly online and partly physically are currently underway at different stages of implementation in six countries – Central African Republic, Democratic Republic of the Congo, Iraq, Mali, Nepal and Senegal. In Africa, where the effort is most advanced, the IAEA and the WHO Regional Office for Africa (WHO AFRO) have been refining the approach since July.
“COVID-19 has exacerbated non-communicable diseases in patients, leading to life-threatening complications. Our work on the cancer agenda must continue,” said coordinator of the noncommunicable diseases programme at WHO AFRO, Jean Marie Dangou. “The Ministries of Health have selected which sites to visit and which stakeholders to meet, which has guided our virtual engagement over the past few months. We are committed to visiting each country once global travel resumes to verify information gathered virtually and discuss results with stakeholders”.
Outcomes of the imPACT Review
The imPACT Reviews culminate in a report containing national-level recommendations for each component of the cancer control continuum to develop evidence-based projects and programmes. Safe radiation medicine practices, an important aspect of cancer control, are also discussed and reviewed during the assessment. Thanks to the existing collaboration through the WHO-IAEA Joint Programme on Cancer Control, imPACT Reviews also contribute to global and regional cancer initiatives on childhood and cervical cancers.
Adapting Reviews to a fully virtual modality comes with some challenges such as technical difficulties, the fatigue produced by hours of on-screen interaction and coordination issues between team members in different time zones. But the benefits are myriad: reduced financial and environmental costs, the possibility of involving more experts in the discussions and the ability to “virtually” visit more health facilities ¾ a major advantage in geographically large countries. The IAEA and its partners will assess how to move forward once travel resumes, taking on board lessons learned from the virtual activities and integrating them into the typical methodology.
For cancer control professionals receiving expert recommendations from the Reviews and continued access to imPACT expertise, even in the middle of a pandemic, is crucial. The professional relationships fostered through imPACT Reviews are long-lasting, far beyond the weeks-long duration of meetings and in-country visits. “This type of partnership allows us to exchange with experts in the field and receive advice and support. This is exactly what we need to keep fighting cancer and ensure that our strategies and actions are the best that our population can receive in the specific context of our country,” said a cervical cancer specialist participating in the virtual imPACT Review in Mali, Ibrahima Teguete.
A virtual helping hand in cancer control
This virtual approach is also being extended to other areas of cancer control planning. Each group of multi-disciplinary experts nominated for an imPACT Review conducts virtual sessions which can cover one or more areas of cancer control that a country could or is providing, from surveillance to palliative care, with considerations given to strengthen the national regulatory infrastructure on the safety of radiation sources and security of radioactive material used for medical purposes. Countries such as Benin, Burundi, Ecuador, Mauritius, Pakistan and Peru are already benefiting from this method of engagement.
The COVID-19 pandemic has had a direct, negative impact on cancer care, affecting both in- and out-patient care in nuclear medicine and radiotherapy departments, including the number of procedures, employee health, availability of essential supplies and availability of personal protective equipment. The IAEA is actively engaged in providing Member States with guidance to enable the continuation of cancer diagnostic and treatment services in the face of the pandemic, using webinars and other IAEA technical cooperation activities. By adapting the way cancer assessments and missions are conducted the IAEA and its partners hope to contribute to better development of cancer care projects, and to make the case for continued investment to tackle the rising burden of cancer.
Ministries of Health interested in requesting an imPACT Review may do so using this form or contacting the in-country WHO representative. For more information on available IAEA support for cancer control, click here, or write to PACT to join one of the upcoming information sessions for IAEA Technical Cooperation project counterparts on cancer control.