Problem: Weak uptake of available cancer screenings; late detection of cancer; high cancer mortality rates.
Solution highlights: The Ministry of Health developed a national cancer screening programme to increase population uptake of existing screening services. Through this programme, health insurance companies proactively send at-risk enrolees personalized invitations to participate in cancer screenings; strong Ministerial leadership provided an overarching direction for the initiative, promoting alignment across key stakeholders; use of available data helped identify key problems and supported tailoring of activities to meet observed gaps in service delivery; national information campaigns, run through various media channels, supported efforts by educating the public on the importance of cancer screenings; the initiative prioritized a proactive approach to addressing cancer mortality, promoting a shift away from the reliance on reactive service provision.
Description of practice
In 2011, the cancer burden in the Czech Republic was among the highest in the OECD with an all-cancer mortality of 240 per 100 000 population, above the OECD average of 211 per 100 000 population. Cancer mortality already accounted for 26% of all deaths and ageing population trends were expected to further increase the cancer burden. While health insurance covered cancer screening services, population uptake of available screenings appeared weak, delaying cancer detection and hindering successful treatment. Late detection of breast, cervical and colorectal cancers drew particular concern and indicated that the provision of available screening services for these cancers was ineffective.
In 2011, the Ministry of Health convened an expert group to develop a national cancer screening programme in partnership with key stakeholders, including the country’s seven health insurance companies. After almost three years of planning, the finalized screening programme proposal was approved in December 2013 and was allocated an initial year of funding by the European Union and the Ministry of Health. Beginning in January 2014, health insurers started sending out personalized letters to eligible enrolees, inviting them to participate in cancer screenings. Screenings are performed by general practitioners or gynaecologists (faecal occult blood test, Pap smear) or specialists (colonoscopy, mammography). Costs for all cancer screening services are covered by health insurance. Alongside this effort, the Ministry of Health ran two mass-media campaigns in 2014 to educate the public on available cancer screening services and to increase public awareness of the associated health benefits. The Institute of Biostatistics and Analyses at Masaryk University is currently conducting an evaluation for the first year of the cancer screening programme in partnership with the National Health Statistics Centre. Results of this evaluation are expected to help inform future directions for the initiative. At present, the Ministry of Health has full responsibility for financing the initiative and has guaranteed funding for activities until 2020.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
Development of the cancer screening programme was driven by the Ministry of Health with support from key stakeholders. The Ministry established an expert group to plan the initiative and connected with medical professionals, health insurance companies and other organizations to ensure that all stakeholders had a consistent understanding of the activities proposed. All seven health insurance companies in the Czech Republic took on the responsibility of encouraging screening in their enrolled populations and worked with primary care providers to promote uptake of available screening services. As they have easy access to the information needed to enable accurate risk profiling, health insurers are responsible for identifying at-risk patients and mailing targeted screening invitations. Primary care providers support this activity by following up with patients about the screening invitations they received and proactively offering opportunistic screenings and referrals. The Institute of Biostatistics and Analyses is overseeing monitoring and evaluation for the initiative in partnership with the National Health Statistics Centre.
The initiative is still in the early stages of implementation and evaluation of its impact is ongoing. As of August 2014, approximately 1.5 million people had been mailed a personalized cancer screening invitation. Millions more have been exposed to educational messages about cancer screenings through the mass-media campaigns.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Olda Pospisil
- Ministry of Health