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Population Morbidity and Mortality Change
WHAT WE ALREADY KNOW
In Bangladesh and other low and middle income countries, breast cancer is an “orphan” or neglected disease in contexts of numerically more frequent other diseases. In contrast then to the situations in high income countries, where perhaps 75% of women with breast cancer can now be cured, less than 25% are cured in low income countries.
THE CHALLENGE: Where do we start in such circumstances to try and close this unconscionable gap in mortality?
We have partnered with Amader Gram, a Bangladeshi non-governmental organiztion which has worked to increase use of information technologies -- computers, internet -- in the rural division of Khulna. With Amader Gram, IBCRF is developing a major implementation research program in Bangladesh to address the above question -- the Amader Gram Breast Care Program.
One first step has been to develop comprehensive Clinical Practice Guidelines, tailored to the Bangladeshi situation. These guidelines are now available for everyone on this IBCRF website and on the Amader Gram Breast Care Website at http://www.agbreastcare.org/
Global health care context:
Across countries, the major challenges in health are:
- Provision of access to all, generally for primary care and particularly for orphan diseases;
- Evidence for specific interventions and widespread implementation of care based on such evidence.
- Value for the financial resources spent.
- Equitable payment systems.
Based on international experience, critical parts of the solutions to these challenges are:
- Generation of intervention effectiveness and then cost effectiveness data and implementation of systems to encourage high compliance with these findings.
- Intensive use of information technology in medical services delivery.
- Development of centralized, coordinated and integrated care system(s) targeting health outcomes, and bundling episodes of care payments.
- Creation of sustainable business models and plans for services.
Case Satement: Breast Cancer in Bangladesh
In 2010, Bangladesh has 80 million women; approximately 30,000 of these develop breast cancer annually, and the majority of these women –perhaps 90%, die of this disease.
In high income countries, approximately 25% of afflicted women with breast cancer die of the disease. The poor outcomes for women in Bangladesh appear consequent to:
1. Human rights issues which lead to lack of any care for the disease at all; and 2. Poor quality or limited efficacy of most care currently available. The broad specific challenges then in Bangladesh are to create some model system to facilitate access to care for all afflicted women, and further then to develop a model system for quality care for women with this orphan disease.
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| Asking women with breast cancer in rural Bangladesh about their problems in getting care | (Left to Right) Reza Salim, Amader Gram, BiBi Russell and Heather Story Steiness, IBCRF |
The mission of the Amader Gram Breast Care Program is to decrease the morbidity and mortality from breast cancer in the Khulna division of Bangladesh through the development of innovative and sustainable social business(es) which:
- Provide education to women and health professionals;
- Provide medical care; and
- Conduct evaluative and research activities to inform policy.
1. Community input structure through three local district committees has been formed; mission statements and governance procedures are in development.
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| Community leaders in Bagerhat and Jessore provide input during Community District Committee meetings (February, 2010). | |||
2. Amader Gram Primary Breast Problem Clinics. Four walk-in clinics are in operation. Over 6,000 women have been seen; half have had objective evidence of a breast problem. More than 280 have had breast cancer.
3. Amader Gram Breast Care Center (Partially supported by a grant for 2010-2013 from Susan B. Komen For the Cure). The most urgent needs of women in the Khulna division are for:
- Efficient specific diagnosis of breast masses
- Coordination of quality care for breast cancer
- Provision of appropriate and safe systemic treatments for breast cancer.
4. Radiation Therapy Center In the Khulna division, there is no radiation therapy capacity at all. While federal government plans have long been to assure such capacity at all major government hospitals, this has not happened and appears unlikely in the Khulna division in the next 5 years. Amader Gram Breast Care is now exploring a partnership with Nobel Laureate Muhammad Yunus and the Grameen Bank in which this entity would purchase a state-of-the-art cobalt tele-therapy machine and Amader Gram would find the land, erect a suitable building, and create a social business to provide such treatment.
To learn more: Write to Dr. Richard Love at richard@ibcrf.org
