Public health trio : the role of non-governmental organizations for cancer care management in Hong Kong's dual track healthcare system

Abstract

In Hong Kong’s dual track healthcare system, public and private health sectors provide professional health service delivery at hospitals and clinics, where non-governmental organizations (NGOs) also provide services for cancer care, in battling the city’s top killer. However, there have been few evaluations of the operations and performance of health-related NGOs and fewer studies on the complementarity and integration of public-private-NGO platforms in public health.

This paper focuses on two major cancer NGOs, Hong Kong Anti-Cancer Society (HKACS) and Hong Kong Cancer Fund (HKCF), regarding their service scope and fund utilization in prevention, early diagnosis, diagnosis and treatment, and palliative care, in filling the service gaps of Hong Kong’s public-private health system in cancer care. HKCAS with the longest history of establishment is providing a wide range of services from prevention to palliative care except early diagnosis and screening. Half of the funds received by HKACS were donations in kind by pharmaceutical companies to patients referred by public hospitals, where HKACS acts like a distributor of donations. HKCF with the strongest community network and fundraising capability is most prominent in filling the gap of raising public awareness on cancer prevention. HKCF also operates eleven patient centres located in public hospitals and in the community, offering free information and psychosocial support to patients and supporting 21 patient self-help groups. Both NGOs play some part in subsidizing patients in receiving diagnosis and treatment at public hospitals, but the extent is limited. Prevention strategy could be extended to include organized and systematic screening through public-private-NGO collaboration. NGO’s involvement in patient journey could be explored by taking proactive approaches and offering in-depth support through coordination with public and private providers. The palliative care offered by HKACS Jockey Club Cancer Rehabilitation Centre (JCCRC), formerly as Hong Kong’s first hospice hospital, Nan Long Hospital, is a unique service by an NGO. Its financial viability and dependence however limit its long term sustainability. Innovative approaches in palliative care by NGOs such as home care services could be explored.

Since the early 1980s, World Health Organization has urged the countries to include all stakeholders including NGOs in the planning and implementation of cancer control programmes. World Cancer Declaration 2013 called for pledged and coordinated efforts of all parties, including the public and private sectors and civil society, including non-governmental organizations, to reduce the global cancer burden, and improve quality of life and survival rates. While NGO-public collaboration is more established due to the subsidization function, NGO-private collaboration could be strengthened to promote public education, enable patient access to latest treatment and facilitate public-private balance in service provision. The integration and collaboration of public-private-NGO should be enhanced to address the impacts of cancer on individuals as well as the whole society to promote, restore and maintain health of the public.