El Salvador has made significant progress in terms of implementing its National Cancer Control Plan, however more efforts are needed to streamline data collection, harmonize the delivery of diagnostic and therapeutic services across institutions, and reliably estimate costs, a team of international experts has found, following a week-long imPACT Review mission carried out on request of El Salvador's Ministry of Health.
The Review - carried out from February to June 2023 - provided the Salvadoran Ministry of Health with a comprehensive overview of existing cancer control efforts in the country and a set of tailor-made recommendations in line with international quality and safety standards.
Among its population of 6.5 million, El Salvador reports just over 9600 new cancer cases annually, primarily of the prostate and breast. The country's public health system provides full coverage of its services to such patients, who are typically referred to one of three national hospitals - Benjamin Bloom, Nacional de la Mujer and Rosales.
"The IAEA's technical cooperation program with El Salvador has been instrumental to support the strengthening of cancer prevention and control initiated by the Government after the imPACT Review in 2015. Therefore, we gladly welcome this important tool, which gives us the opportunity to periodically evaluate the progress made and to develop new strategies adapted to the capacities and needs of the country," said Adriana Mira, Vice-minister of Foreign Affairs of El Salvador.
The Ministry of Health facilitated visits by the international imPACT team - comprising 11 cancer professionals appointed by IAEA, PAHO and IARC-to 18 hospitals and health clinics. This included a field trip to the regional hospital of Santa Ana and meeting more than 100 national health professionals as part of the Review.
The imPACT Review included several visits to cancer care facilities, including the radiotherapy service at the Salvadoran Institute of Social Security. (Photo: G. Saporiti/IAEA)
Coupled with the data that was collected and analysed on the cancer control situation in the country between February and May 2023, the findings of these visits led to a full set of recommendations for inclusion in the imPACT report to be shared with the El Salvador Government by September 2023.
A key recommendation highlighted the need to synergise diagnostic and therapeutic services provided by separate institutions, fostering a more comprehensive, holistic approach to cancer care. The report also recommended standardizing cancer-specific monitoring and evaluation capacities to support the substantial efforts currently underway to create a national Health Information System. This would enable the government to rely on evidence-based planning and to develop a cost structure of procedures and benefits related to cancer screening, diagnosis and treatment for inclusion in the National Cancer Control Plan.
As part of the Review process, some crosscutting elements from within the report were highlighted and presented to the Vice-Minister of Health Management and Development, Carlos Gabriel Alvarenga Cardoza, and to the Vice-Minister of Health Operations, Karla Marina Díaz de Naves.
"There are not only challenges, but also opportunities, emerging from this imPACT Review," said Giovanni Escalante, PAHO Representative to El Salvador. "We will support the joint actions with the Ministry of Health in order to reinforce the design and implementation of a National Cancer Control Plan, including the follow-up of strategic lines derived from the imPACT evaluation."
A history of cooperation among Salvadoran and IAEA experts
The Nuclear Medicine Service of the Rosales National Hospital is just one cancer control and care institution, which has benefitted from support from the IAEA's technical cooperation programme. (Photo: O. Alonso/IAEA)
With the support delivered through two prior imPACT Reviews - in 2010 and in 2015-cancer experts and health policy makers in El Salvador have made large strides in the development of cancer control infrastructure, the training of qualified personnel and the implementation of effective policies.
Summarizing the achievements realized since the 2015 imPACT Review, Karla de Palma, General Director of the Salvadoran Agency for International Cooperation, pointed to the "recently installed gamma camera at the Rosales Hospital, the enrolment of a cadre of Salvadoran professionals in nuclear medicine and medical physics master's programmes, as well as the medical staff and nurses of the Rosales Hospital and the National Radiotherapy Centre with the aim to improve nuclear medicine and radiotherapy services."
Following the recommendations of the 2015 imPACT Review, the Salvadoran Government adopted a national law for the prevention, control and care of patients with cancer; launched the construction of a national radiotherapy center; and developed new cancer screening and early detection schemes.
"El Salvador has made important steps towards promoting a system of care that maintains quality standards and is accessible to all," Alvarenga Cardoza said. "We know that there is still a long way to go, but this review, carried out together with the three agencies, allows us to chart the course and direct the important investments that the government is preparing to further strengthen the health system and specifically for cancer prevention and control."
