After 119 weeks of passing the Comprehensive Cancer Care Law ―March 7, 2024―, the Ministry of Health published on June 24 the regulations that will allow the application of the standard, which was created with the purpose of providing specialized assistance to patients within a health system that has the capacity for early detection, provides treatment and follows up on patients.
The regulation is made up of 93 articles and 14 chapters, which detail the integration of an entire structure that will allow the regulations to be implemented, which will be in charge of the ministry. But, in the opinion of patients and civil society, Forming each of the nine units mentioned in the instrument will take timeso it could take several years for the problems of lack of care for cancer patients to be resolved.
In the first instance, you must create the National Directorate of Comprehensive Cancer Carewhich will be responsible for coordinating policies, regulations, planning, surveillance and articulating, at the national level, care for the population. They also have to integrate the National Cancer Council, he Pharmacotherapy Committeethe National Cancer Support Network and the Work Tablesin which specialized personnel must be involved in treating the disease, in addition to the participation of the health services network to provide comprehensive care.
As part of the components to be implemented, and to which priority must be given, is the National Cancer Registry, which will allow us to have reliable information on incidence, mortality, survival and prevalence of the disease in the country, to guide decision-making and planning in health services. Furthermore, there is the basic list of medicationswhich is subject to pharmacotherapy protocols and guidelines, in accordance with local epidemiological characteristics.
The specialization of human resources is another of the points that the regulation addresses, for the education, training and specialization of health personnel in the field of oncology; but the process must be continuous to develop capabilities at all levels of care and with cultural relevance. The investigation It must also be promoted, and the ministry must guarantee the resources to implement it.
The regulation indicates the creation of the Specialized Cancer Hospitalwhich must have a radiotherapy unit, medical equipment, medications and trained human resources (technician, specialized professional and administrative). Although on February 13, the Ministry of Health and the Embassy of China (Taiwan) in Guatemala signed an agreement to build it, There is no date for the start of work on the land.
According to Minister Joaquín Barnoya, the processes are “bureaucratic” for the creation of each of the structures mentioned in the instrument that will give life to the law. But progress has already been made with “putting cancer within the legal structure of the ministry.”
Others involved
The Ministry of Health is the governing body of the Comprehensive Cancer Care Law, but in its implementation there are other ministries that also collaborate, and the regulations establish their functions.
For example, the Ministry of Education It must include content on cancer prevention and healthy lifestyles in the National Base Curriculum, in addition to coordinating educational activities to promote vaccination against the human papillomavirus (HPV) among students.
He Ministry of Labor must create social protection programs for cancer patients and survivors, such as employment insertion, occupational training and protection of the labor rights of cancer patients.
It is regulated that the Ministry of Social Development It has to integrate people with cancer and their families into social protection programs. While the Ministry of Public Finance must guarantee the funds to implement the law.
He Guatemalan Institute of Social Securitythe municipalities, the universities and the public and specialized hospitals They must also be involved in compliance with regulations. It includes patient organizations and civil society that make up the National Cancer Support Networkr, whose role is important in social audit processes.
Dissatisfied
Last year, patients and civil society raised their voices to express their concern about a regulation of the Comprehensive Cancer Care Law that was being worked on behind “closed doors.” They managed to be included in some work tables and presented your observations to the document; However, today they point out that were not taken into account.
“Our preliminary review of the published text indicates that the substantial changes that we proposed were not incorporated. It is not a question of whether the proposals were accepted or not; it is that several of them sought for the regulation to fully develop the spirit and mandate of the Comprehensive Cancer Care Law,” indicates the organization Voice for Cancer.
Although the publication of the regulation represents an important step, it does not close the discussion, so they will continue to monitor its implementation to guarantee better care for people with cancer.
Lea Echeverría, a specialist in psycho-oncology and who has followed up on the law, points out that “there are gaps” and “ambiguities” that were not resolved in the draft they learned about last year, such as the training of human resources, the strengthening existing care units, and that there is no “direct impact” on the well-being of the patient and their families in the short term.
In Echeverría’s opinion, it could take a decade for the Comprehensive Cancer Care Law to really improve the population’s care, and the biggest concern is that everything remains on paper.
“There are gaps and it is worrying because (the regulation) is already authorized. The future of cancer for me remains uncertain. They created a program to visualize it in a few years, but everything will depend on the government that remains,” adds the psycho-oncologist.
For Mirna Montenegro, from the Sexual and Reproductive Health Observatory (Osar), the publication of the regulation represents progress for the implementation of the law, as it complies with developing the content of the regulations. He adds that, during the dialogue process that took place last year with the Ministry of Health, contributions such as governance were incorporated into the formation of the National Cancer Support Network, which is important, but it is important to establish a schedule to implement what is expressed in the document.