Building Resilient Cancer Care Ecosystems from the Ground Up

City Cancer Challenge Headquarters: Switzerland
Project Countries: Ghana, Rwanda, Colombia
Keywords: cancer care, low- and middle-income countries (LMICs), health systems, public-private collaboration, city-level action

Summary

While low-and middle-income countries (LMICs) now shoulder most of the cancer burden at 70% of cancer deaths worldwide, effective treatment remains impeded by health system challenges, as cancer survival depends not on a single intervention, but on the effectiveness of the entire cancer care ecosystem. Recognizing this, City Cancer Challenge (C/Can), an impact-driven NGO, has reimagined the city as the primary unit of intervention. By working within existing health systems, C/Can supports locally led cancer care ecosystems that deliver incremental and sustainable improvements and ultimately lay the foundation for broader national health system transformation.

Key Figures

Partner's Information

City Cancer Challenge (C/Can) supports cities around the world as they work to improve access to equitable, quality cancer care. It leads a city-based partnership initiative that aims to improve access to quality cancer care in cities around the world by transforming the way stakeholders from the public and private sectors collectively design, plan, and implement cancer solutions. C/Can was launched by the Union for International Cancer Control (UICC) at the 2017 World Economic Forum Annual Meeting in Davos. It was established as a standalone Swiss foundation in January 2019.

Background & Challenge

Among non-communicable diseases (NCDs), cancer is one of the fastest-growing and most complex global health challenges. The burden is increasing most rapidly in low- and middle-income countries (LMICs), where nearly 70% of cancer deaths occur. Yet many LMIC health systems remain ill-equipped to respond, facing persistent challenges in financing, infrastructure, workforce capacity, and service integration. These systemic weaknesses are particularly detrimental to cancer care, which depends on a coordinated continuum of services--from early detection and diagnosis to treatment and palliative care. When any part of this continuum is weak or unavailable, delays increase, treatment outcomes worsen, and avoidable mortality rises.

Approach

C/Can deliberately departs from traditional development models that introduce pre-defined solutions alongside public systems. Instead, it works from within through its rigorous yet flexible City Engagement Process, helping local stakeholders identify their cancer care gaps and co-create solutions tailored to their context. Each city engagement begins with comprehensive stakeholder mapping, leading to the formation of a multi-sectoral City Executive Committee (CEC) that brings together decision-makers from government, clinical practice, academia, and hospital leadership. This multi-institutional composition allows the CEC to assemble interdisciplinary working groups which are then uniquely qualified to carry out a data-driven needs assessment based on local cancer care capacity.

Once data is fully analyzed, it is translated into a City Action Plan that guides implementation. Equity is a defining principle of this approach. Since a patient's diagnosis pathway in LMICs can vary significantly depending on whether they enter a public hospital or a private clinic, C/Can facilitates the creation of Resource-Appropriate Guidelines that combat inequity by reflecting real-world constraints rather than idealized and aspirational standards.

Impact & Results

To move beyond simple output metrics, C/Can utilizes the City Assessment Dimension (CAD) framework. This tool measures "System Readiness" and tracks performance indicators that signal the health of the entire ecosystem. In Kumasi, Ghana, local stakeholders co-created "Oncokids," a digital referral app connecting 24 facilities. Combined with training for 120 health workers, this tool led to a 3.5-fold increase in successful referrals in just one year.

Across C/Can cities, lead indicators tracked through the City Assessment Dimension validate the impact of a systems-based approach: in Kigali, Rwanda, the strengthening of referral pathways and diagnostic capacity reduced the average time from diagnosis to treatment from 82 days to just 28. In Cali, Colombia, improved patient navigation systems led to a 15% reduction in patient dropout rates. Overall, more than 937,000 cancer patients have been reached across C/Can cities by 2025.

Future Outlook

Looking forward, C/Can is exploring new models to scale impact, including "asset sharing" - open-sourcing technical tools for global use (15 cancer management guidelines already developed across 5 types of cancer) - and piloting a "Simplified Engagement Process" for governments requesting targeted assistance. By turning local lessons into global assets, C/Can demonstrates that the most effective way to fix a national healthcare system is to start from the ground up.