Palestine Cancer Strategy Development

1. Purpose of the Consultancy

The purpose of this consultancy is to support the development of a national cancer strategy for the Occupied Palestinian territories (West Bank and Gaza) drawing on the findings and recommendations of the WHO/IARC Joint Cancer Review Mission report from 2019.

2. Background

Occupied Palestinian territory (OPt) has a significant burden of Non communicable diseases (NCDs) and an increasing cancer incidence. Currently, cancer is the second leading cause of death responsible for 15.5 % of all deaths. According to the 2019 Ministry of Health (MOH) annual report, the reported number of new cancer cases in West Bank in 2019 was 3,164 cases with an incidence rate of 117.8 per 100,000 population. In 2019, breast cancer was the number one cancer type constituting 16.9% of all cancer cases. Colorectal cancer and lung cancer were reported as the second and the third most common cancers (12.6% and 7.2% of all reported cancers respectively)

Significant increase in the number of new cancer cases has been reported in the country. It is estimated that by the year 2040 the number of new cancer cases in OPt will be more than double the current number. The change in population dynamics (population growth, increased longevity) and improved detection facilities are the main contributors to the rising trend. However, important risk factors like smoking, obesity, unhealthy diet, and physical inactivity can also have a significant role to increase the cancer burden.

A steady increase in the number of cancer patients has also been reported in the Gaza Strip from 2011 to 2018. In 2011, the number of new cases detected was 1,037, with an incidence of 65.2 per 100,000 population. The corresponding figures for 2018 were 1,941 and 97.9 per 100,000 population respectively.

The restrictions on movement has serious implications on the cancer clinical pathway, management, and health outcome of patients within OPt, resulting in delay of diagnosis and treatment due to geographical barriers, complicated security procedures and the permit systems . Mobility restrictions affect both the WB and GS although the the situation is more dire and complicated in the latter.

Some of the key findings from the Joint WHO/IARC cancer review mission in 2019 included (i) the shortage of specialized oncology workforce, (ii) inefficient referral procedures, (iii) lack of nationally agreed clinical protocols and updated Essential Medicine Lists (EML), and (iv) limited availability of essential medicine supply challenging planning and efficient organization of health care services. Although the needs and challenges were similar across the OPt, the situation remains more difficult in Gaza due to the decade long land, sea and air blockade and the extreme mobility restrictions affecting the health system planning and capacity.

The MoH covers the costs of primary, secondary, and tertiary cancer services. Currently, oncology services are primarily provided in general hospitals, while the provision of specialist care often requires referrals for treatment to facilities outside of the MoH hospitals to either AVH in the West Bank or abroad, especially when patients require radiotherapy or advanced diagnostic procedures. In addition to the increased costs related to these referrals, they also lead to patients facing social and logistical challenges due to receiving care far away from home, family and caregivers.

The Palestinian National Institute of Public Health (PNIPH) is one of the World Health Organization (WHO) projects in close cooperation with the Palestinian Ministry of Health (MoH) and the Norwegian Institute of Public Health (NIPH) that has been working heavily with stakeholders to strengthen the essential public health functions and the health system in Palestine through the provision of accurate, reliable data and evidence-based information.

The PNIPH is working with the Ministry of Health and other stakeholders to assess and strengthen the current national health system across the different levels of care. The review of oncology health services in Palestine is an opportunity to highlight major gaps and opportunities for improvements, as well as improving the availability, accessibility, quality, and efficiency of oncology services in OPt.

3. Objectives, outputs and deliverables

The main objective of this consultancy is to develop a national cancer strategy that defines strategic priorities and related interventions in oncology in OPt for the medium and long term. These priorities should be informed by the findings and recommendations of the Joint WHO/IARC cancer review mission report from 2019 and agreed upon through an inclusive and collaborative process led by the national cancer committee and involving other relevant national stakeholders active in cancer prevention and control.

Output 1: Draft national cancer prevention and control strategy

• Engage the national cancer committee in the development of a draft strategy and nominate technical sub working groups to give input to key areas of the strategy;
• Develop a draft strategy that provides strategic guidance for the national cancer control programme and is aligned with overall NCD prevention and control strategy/action plan and other national health and development priorities;
• Identify goals and objectives, target populations, priority cancers and strategies for interventions in line with country burden and needs;
• Ensure that the draft strategy is evidence-based and developed in line with relevant WHO guidance and recommendations.

• Ensure that draft strategy includes interventions and health system considerations across the continuum of care:

  • Prevention
  • Early detection
  • Diagnosis
  • Treatment (all modalities)
  • Palliative care
  • Rehabilitation and support

• Consider core health system principles such as equity of access (including geographic proximity), quality of care, and affordability;

• Ensure inclusion of aspects related to oncology workforce planning and as well as strengthening of cancer surveillance and research activities.

Deliverable 1: Draft national cancer prevention and control strategy

Output 2: National workshop involving cancer stakeholders for review and endorsement of draft strategy.

• Comprehensive mapping of oncology experts and stakeholders in OPt (Gaza and West Bank) active in cancer prevention and control to inform participation at national workshop and/or later engagement in implementation phase.
• Prepare and facilitate national workshop with engagement of established national cancer committee and other stakeholders (drawing on above mentioned stakeholder mapping) as deemed appropriate while ensuring representative and fair participation.
• Prepare a draft agenda for an interactive workshop/dialogue to allow an inclusive and collaborative review of key sections of the draft strategy.
• Facilitate workshop and ensure incorporation of gathered input to the final version of the strategy;
• Discuss and agree on user-friendly and contextually appropriate indicators for monitoring and evaluation.

Deliverable 2: Reviewed and endorsed national cancer prevention and control strategy

Output 3: Implementation plan

• Coordinate the planning and implementation of the priority interventions agreed upon under the guidance of the Ministry of Health (national cancer steering committee) in collaboration with implementing partners/facilities/institutions;
• Discuss and agree on user-friendly and contextually appropriate monitoring framework for the implementation of priority interventions.

Deliverable 3: Implementation plan with detailed budget and timeline

4. Planned timelines

Start date: February 15, 2022

End date: November 15, 2022

Specific requirements

- Qualifications required:

Essential Minimum first university degree in Medicine for lower end of range, an advanced university degree for mid and high end of range

Experience required:

5 to 10 years experience in public health policy and health programme planning.

Skills / Technical skills and knowledge:

- Demonstrated ability to work in a multi-cultural environment and establish harmonious and effective working relationships through a diplomatic and inclusive approach.

- Excellent knowledge of cancer continuum of care interventions and planning of cancer prevention and control programmes at national level.

Language requirements:

Excellent English speaking and writing skills. Knowledge of Arabic desirable.

Place of assignmentWorkplace will be WHO-country office in Ramallah/West Bank and from his home.Local team/ consultant will support the consultant with the assigned consultancy task and certain activities to facilitate the completion of the consultancy task

Medical clearance

The selected Consultant will be expected to provide a medical certificate of fitness for work.

Travel

The incumbent may need to travel to Palestine for work purposes under organizational rules and regulation