Table 5 List of 54 selected right-to-health indicators in breast cancer care and management
Health service delivery |
|---|
Structural indicators |
 1. In the NCP or NCDP there is a strategy to implement population-based breast cancer screening |
 2. In the NCP or NCDP there is a strategy to implement access to radiotherapy |
 3. In the NCP or NCDP there is a strategy to implement palliative/supportive care |
 4. In the NCP or NCDP there is a strategy to implement survivorship care |
 5. In the NCP or NCDP there is a strategy to implement end-of-life care |
Process indicators |
 6. There is a referral system in place from primary care to oncology services |
 7. There is a specified maximum waiting time between diagnostic suspicion in primary care and the first appointment with an oncologist |
 8. There is a specified maximum waiting time between the confirmed diagnostic and the first appointment for treatment |
 9. The national diagnosis guidelines involve pathological evaluation in line with ESMO or ASCO recommendations |
 10. The number of radiotherapy units is at least as high as the optimal threshold set by the IAEA (one radiotherapy unit per 500,000 population) |
  Disaggregated by geography |
 11. There is a referral system in place from the breast unit to psychological care |
  Disaggregated by geography |
 12. There is a trained member of staff acting as patient navigator in the breast unit |
  Disaggregated by geography |
Outcome indicators |
 13. Proportion of suspected breast cancer patients with a first consultant appointment within 2 weeks of primary care referral |
 14. Proportion of women with advanced breast cancer (stage IV) at diagnosis |
  Disaggregated by wealth quintile and ethnicity |
 15. Proportion of breast cancer patients forgoing or postponing care because of limited availability |
  Disaggregated by wealth quintile and ethnicity |
 16. Proportion of breast cancer patients forgoing care because of affordability |
  Disaggregated by wealth quintile and ethnicity |
 17. Proportion of breast cancer patients who receive palliative care |
  Disaggregated by wealth quintile and ethnicity |
 18. Proportion of women terminally ill with breast cancer who receive end-of-life care |
  Disaggregated by wealth quintile and ethnicity |
Health system financing |
Structural indicators |
 19. The NCP or NCDP addresses costs of implementation of the breast cancer strategy |
 20. Share of government spending and out-of-pocket payment out of the total spending on health per capita |
 21. The state has a social health insurance system |
Process indicators |
 22. The social health insurance system covers diagnostic services for breast cancer (i.e., biopsy, mammogram and ultrasound) |
 23. The social health insurance system covers breast cancer treatment (i.e., hormone therapy and chemotherapy) |
 24. The social health insurance system covers radiotherapy for breast cancer |
 25. The social health insurance system covers palliative care for breast cancer |
Outcome indicators |
 26. Proportion of costs covered for breast cancer care by the social health insurance system |
Medicines |
Structural indicators |
 27. There is an official national medicines policy to provide access to essential medicines |
 28. The NCP or NCDP mentions breast cancer medicines included in the WHO Essential Medicines List |
Process indicators |
 29. Proportion of breast cancer medicines included in the WHO Essential Medicines List that are available in the country and covered by public funding |
Outcome indicators |
 30. Proportion of hospitals with palliative medicines shortage |
  Disaggregated by geography |
Health workforce |
Structural indicators |
 31. The state has a national health workforce strategy |
Process indicators |
 None selected |
Outcome indicators |
 32. Prevalence of certified oncologists per 1,000,000 population |
  Disaggregated by geography |
Health information systems |
Structural indicators |
 33. The state law requires informed consent to treatment and other health interventions |
 34. The NCP or NCDP protects the right to seek and receive health information |
 35. The NCP or NCDP addresses communication of information throughout the pathway of care for breast cancer, from screening through to referral, diagnosis, treatment options and palliative care |
 36. The NCP or NCDP addresses the needs of patients from culturally and linguistically diverse backgrounds |
 37. The NCP or NCDP addresses participation of patients in decisions that affect them |
Process indicators |
 38. The personnel in the breast unit are trained to communicate information on diagnosis and treatment options, including side effects and survival, repeatedly, verbally and in writing, in a comprehensive and easily understandable form to patients |
 39. The personnel in the breast unit presents all options available to the patient beside a mastectomy, and explains in an easily understandable way psychological distress that may be associated with a mastectomy |
 40. The personnel in the breast unit discusses breast reconstruction techniques individually taking into account anatomic, treatment- and patient-related factors and preferences |
 41. The breast cancer unit uses trained interpreters when communicating with patients from culturally and linguistically diverse background |
 42. The breast unit has a participatory process in place to include patients into decisions that affect them individually |
Outcome indicators |
 43. Proportion of breast cancer patients who feel they have received sufficient, comprehensive and easily understandable information, including on treatment side effects and survival, to be involved in decisions about their care |
  Disaggregated by wealth quintile, ethnicity, and language |
 44. Proportion of breast cancer patients who feel they have been involved in decisions about their care |
Governance and leadership |
Structural indicators |
 45. The Constitution, Bill of Rights, or other statute recognises the right to health |
 46. The NCP or NCDP addresses accountability of the state and health institutions |
 47. The NCP or NCDP includes a protection against discrimination |
 48. The NCP or NCDP includes an explicit commitment to universal access to cancer services and treatment |
 49. The NCP or NCDP includes a set of targets and progress indicators specific to breast cancer |
Process indicators |
 None selected |
Outcome indicators |
 None selected |
Underlying determinants of breast cancer |
Structural indicators |
 None selected |
Process indicators |
 None selected |
Outcome indicators |
 None selected |
Accountability and redress |
Structural indicators |
 50. There is an accessible pre-judicial mechanism to lodge complaints alleging breach of obligations connected to the right to health |
Process indicators |
 51. The breast unit has a formal complaints mechanism for patients |
Outcome indicators |
 None selected |
Additional indicators suggested in round 1 and selected in round 2 |
 52. Proportion of the population at risk participating in the screening programme |
 53. Prevalence of certified nurses per 1,000,000 population |
 54. The State has ratified key human rights treaties recognising the right to health |