Bolivia has taken a critical step towards strengthening its cancer control system by hosting an imPACT Review mission led by the IAEA, the World Health Organization (WHO), and the International Agency for Research on Cancer (IARC). Over the course of ten days in August, national and international experts conducted a thorough evaluation of Bolivia's cancer care infrastructure, from prevention to diagnosis to treatment to palliative care, focusing on current gaps and areas for development.
Bolivia's increasing cancer burden - in particular for cervical cancer, for which Bolivia has one of the highest incidence rates in the region (22 per cent of all female cancer cases), but also for prostate and breast cancers (25 per cent of male and 17 per cent of female cases respectively) - underscored the urgency of the mission (Globocan 2022). Despite efforts to decentralize cancer services and enhance cooperation among health subsystems, infrastructure and human resources remain concentrated in the country's main cities (La Paz, Santa Cruz and Cochabamba). This centralization restricts access to cancer services, presenting ongoing challenges to achieving equitable care nationwide.
Cervical cancer was a central focus of the review due to its high incidence in Bolivia. While the government has made significant progress in expanding human papillomavirus (HPV) vaccination and screening programmes, which protect against cervical cancer, the imPACT team urged further expansion of high-accuracy HPV testing and increased awareness and access to the vaccination in underserved areas. The integration of cervical cancer screening with other cancer control efforts was recommended to enhance coordination and improve patient outcomes.
"Addressing cervical cancer must remain a national priority given the high incidence in Bolivia," said Vice Minister Mariana Ramírez in her remarks at the end of the mission. "Expanding access to early screening and HPV vaccination is essential for saving lives," she added.
For all cancer types, major efforts have been made to purchase the technology needed to ensure the quality and timeliness of diagnosis and treatment services across the country, but the distribution of infrastructure, technology and human resources in the public cancer care system remains uneven. Patients face long delays, extended waiting lists and may be forced to travel to the capital to receive adequate diagnosis and treatment. A key recommendation of the imPACT Review was therefore to establish agreements between health subsystems to optimize the use of diagnostic tools and medical equipment. Investments in radiotherapy and nuclear medicine were also deemed critical, as many cancer patients lack access to essential treatment options. Ensuring regular maintenance and the modernization of equipment was recommended to help the country maintain high-quality care standards.
"Improving the efficiency and capacity of Bolivia's diagnostic and treatment systems is not only urgent but feasible," said Ramírez. "By maximizing the use of available resources and investing in the necessary equipment, we can significantly reduce the burden of cancer in the country."
During the ten-day mission, the team of international and national experts visited the ABEN Nuclear Medicine and Radiotherapy Center (El Alto). (Photo: Ministry of Health and Sports Bolivia)
St. Jude Children's Research Hospital contributed to the imPACT Review by funding a dedicated planning workshop on paediatric cancer. This workshop helped prioritize the need for advanced diagnostic techniques, such as immunophenotyping and genetic testing, to enhance early diagnosis and improve treatment outcomes, particularly for children with leukaemia.
During the mission, IAEA experts also met with Hortensia Jiménez, Director General of the Bolivian Agency for Nuclear Energy (ABEN). "Regulatory infrastructure is crucial to ensuring that technology for cancer diagnosis and treatment is used safely and in line with international standards," said Jiménez. "The recommendations provided in this area will help us to ensure patient and staff safety," she added.
The review was also an opportunity to assess the health information systems in place for cancer data collection and analysis. To support informed planning and policymaking, experts on the mission recommended that Bolivia standardize its hospital-based cancer registries, establish a national paediatric cancer registry, and upgrade pathology services to allow for more accurate assessments of national cancer trends and timelier, evidence-based interventions.
At the end of the mission, a two-day workshop brought together over 80 national stakeholders to validate the preliminary findings and discuss next steps. Minister of Health and Sports María Renée Castro emphasized the significance of the imPACT review's conclusions, a sentiment echoed by Vice Minister Mariana Ramírez during a debriefing meeting with the imPACT team. The recommendations, which were developed in close collaboration with national stakeholders, will help shape the priorities of the forthcoming National Cancer Control Plan and provide a solid foundation for tracking progress and assessing the impact of cancer prevention and control initiatives on the health and well-being of Bolivia's population.
"The imPACT mission is a pivotal moment for Bolivia as we work towards building a comprehensive, evidence-based cancer control strategy. This mission has provided us with the insights and tools necessary to improve our health system's capacity to prevent, diagnose and treat cancer, ensuring that more Bolivians have access to timely, high-quality care" emphasized Alma Morales Salinas, the Pan American Health Organization Representative to Bolivia.
At the end of the mission, the team held a debriefing meeting with the Vice Minister of Health Mariana Ramírez to communicate key findings and recommendations. (Photo: G. Saporiti/IAEA)
