Policy strategies for capacity building and scale up of the workforce for comprehensive cancer care: a systematic review

Abstract

Background: Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers.

Materials and methods: We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377).

Results: The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited.

Conclusions: Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.

Keywords: AAAQ; SWOT; WHO Strategy; cancer policy; cancer workforce; capacity-building; global oncology.

Figure 1

Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow chart of the systematic review.

Figure 2

Health providers addressed by the workforce interventions in the systematic review. Note: A single paper could report a strategy intended for a single or multiple types of providers. Surgical oncologists include one neurosurgeon. Other: multidisciplinary team (occupations not specified), native health workers, health care professionals in supportive care of patients with cancer, medical social worker, one data manager, one outreach worker, local medical officer, assistant medical officer, caregiver, ophthalmology medical officer, office staff, social worker, community health advisors, rural health care providers, patient navigator, primary care physician, medical student, and radiology nurse.

Figure 3

Countries and institutions where the workforce strategies were formulated, funded, and implemented. (A) Distribution of the countries where the workforce strategies were formulated (outer circle) and implemented (inner circle), according to the WHO Region. (B) Countries where the funding institutions were based (above) and countries where the workforce strategies were implemented (below), according to the WHO Region. (C) Distribution of the countries where the workforce strategies were formulated (outer circle) and implemented (inner circle), according to the WB income grouping. (D) Countries where the funding institutions were based (above) and countries where the workforce strategies were implemented (below), according to the WB income groupings. WHO Regions: AFRO, African; AMRO, American; EMRO, Eastern-Mediterranean; EURO, European; SEARO, South-East Asian; WPRO, West-Pacific. WB grouping: HIC, high-income country; LIC, low-income country; LMIC, lower-middle income country; UMIC, upper-middle income country. WB, World Bank; WHO, World Health Organization.

Figure 4

Workforce strategies identified in the systematic review across the cancer continuum of care.