Joe Harford, Ph'D'

1
Should We Jump into Planning Without a
Plan? or Enough with Planning AlreadyGet to Work!
Joe Harford, Ph.D. Director, Office of
International Affairs National Cancer
Institute UICC Strategic Leader for Knowledge
Transfer harfordj_at_nih.gov
Views expressed do not necessarily reflect the
position of the NCI or the UICC in fact it is
unlikely that they do!
2
National Cancer Control Planning
Pro
Contra
vs.
Failing to plan is planning to fail.
What, me plan?
3
National Cancer Control Planning
Pro
Contra
vs.
I
Failing to plan is planning to fail.
What, me plan?
4
The Bout by the Spout
Sutcliffe vs. Harford Aug. 29, 2008 Geneva
The Thrilla in Manilla Ali vs. Frazier Oct. 1,
1975
The Rumble in the Jungle Ali vs. Foreman Oct.
30, 1974
The Bout by the Spout Sutcliffe vs. Harford Aug.
29, 2008
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Pro
Contra
Harfords Positions

Baseball

Apple Pie

Motherhood
6
When did strategic planning emerge from the
primordial ooze of unplanned action?
Now heres an advanced organism. Youll note the
nucleus and cytoplasm development, along with
what appears to be the first draft of a strategic
plan.
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WHA 58.22 Cancer Prevention and Control (excerpts
related to planning)

• Mindful of the need for careful planning and
  priority-setting in the use of resources in order
  to undertake effective activities to reduce the
  cancer burden
• Urges Member States
• To collaborate with the Organization in
  development and reinforcing comprehensive
  cancer-control programmes tailored to the
  socioeconomic context, and aimed at reducing
  cancer incidence and mortality and improving the
  quality of life of cancer patients and their
  families, specifically through the systemic,
  stepwise and equitable implementation of
  evidence-based strategies for prevention, early
  detection, diagnosis, treatment, rehabilitation
  and palliative care, and to evaluate the impact
  of implementing such programmes.

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WHA 58.22 Cancer Prevention and Control (excerpts
related to planning)

• Urges Member States
• To set priorities based on the national burden of
  cancer, resource availability and health system
  capacity for cancer-prevention, control, and
  palliative-care programmes.
• To integrate national cancer-control programmes
  in existing health systems that set out
  outcome-oriented and measurable goals and
  objectives for the short, medium, and long term
• To consider an approach in the planning
  implementation and evaluation phases of cancer
  control that involves all key stakeholders
  representing governmental, nongovernmental and
  community-based organizations, including those
  representing patients and their families.
• 18.To accord high priority to cancer-control
  planning and implementation for high-risk groups,
  including relatives of patients and those having
  experienced long-duration and high intensity
  carcinogen exposure.

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Q. Is it required that national cancer plans be
originated within the ministry of health of a
country?
Although they must eventually be embraced by
government to be fully effective, national cancer
plans may be developed outside the government,
such as those spearheaded by NGOs. (IOM Report
Cancer Control Opportunities in Low- and
Middle-Income Countries)
UICC Publication for NGOs
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If you dont know where you are going, any road
will get you there. Lewis Carroll
Planning involves

• An honest understanding of an organization's
  history.
• A systematic examination of an organization's
  environment.
• The rigorous assessment of an organization's
  mission.
• Clear vision of organizational goals.
• A mapping process presenting ways of reaching
  those goals.
• An inclusive, collaborative process for gathering
  information, ideas, opinions and intuitions on
  which goals and decisions are based.
• A realization that planning never stops.

• It appears that talking about planning also
  never stops.

Source E. Taylor (http www.nea.gov/resources/Les
sons/Taylor.html)
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1993
1995
2006
2002
The WHO who cried Plan
The boy who cried Wolf
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A well-conceived, well-managed national cancer
control programme lowers cancer incidence and
improves the life of cancer patients, no matter
what resource constraints a country faces.
(from the WHO website)
Not all evidence is created equal! What evidence
is there that cancer planning makes a difference?
(Q. Does one have to be opinionated to be an
expert?)
Q. Is cancer control planning a faith-based
activity?
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Q. Is cancer control planning a faith-based
activity?

• A lot of talk about the need for planning and
  how to plan has been going on for a long time.
• Much less actual planning has occurred in the
  same period.
• Even less implementation of existing plans with
  measurable outcomes has occurred.
• As a result, the evidence that planning leads
  to better outcomes for cancer is scant.

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Preface More than 40 countries have already
instituted NCCPs or received comprehensive
grounding in their principles and operation. The
target for the year 2000 is for this number to
exceed 100 some programmes will serve as
demonstration projects, with carefully monitored
and evaluated indicators for implementation. Ja
n Stjernsward Chief, Cancer Palliative
Care World Health Organization
1995
Not sure what this means, but it apparently
didnt take.
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Which countries have comprehensive cancer control
plans now?



State level

Endorsed by Govt
In Preparation
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Q. What is needed to improve upon our current
condition via planning?

• We need to know what our current condition is.
• We need metrics to measure progress (or
  deterioration).
• We need a plan.
• We need a genuine desire to improve that is
  manifest in action (and spending) and not in
  words alone.
• We need resources to implement our plans and
  assessment activities.

Conclusion A plan is necessary but not
sufficient.
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Talking about planning and planning to plan
We are here for the most part
A Plan
Act
Adjust
Assess
A plan needs to be coupled with action,
assessment, and adjustment.
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RECOMMENDATION Cancer control plans should be
developed, or updated, in each country every 3 to
5 years through a process that involves all major
stakeholders, public and private sectors, as
described by WHO, UICC, and others. Cancer
control plans should be promoted and supported
financially and programmatically through both
government action and public advocacy. In both
the planning and implementation phases, global
partners should provide necessary guidance and
financial support.
IOM report produced in 2007 with support of NCI
and ACS
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What about commitment to implement plans?
Follow the money. Deep Throat to Bob
Woodward All the Presidents Men
Q. What would you conclude about a countrys
commitment to planning for National Cancer
Control Programmes if nothing were being spent on
same by the country?
Q. What would you conclude about the commitment
of the member states of WHO to cancer control if
they pass a cancer control resolution but the WHO
budget contains little specific funding for
cancer?
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Planning vs. Doing
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Knowing vs. Doing
Knowing is not enough, we must apply. Willing is
not enough, we must do.
Goethe
To talk the talk is not enough, we must walk the
walk. Planning is not enough, we must move to
avoid analysis-paralysis. Having meetings
about planning is not enough, someone must pay
for planning implementation.
Apologies to Goethe