My Child Matters: An initiative of the Sanofi Espoir Foundation
Valentine Leuenberger, Laurence Bollack, Valérie Faillat and François Desbrandes, Sanofi Espoir Foundation; and Julia Challinor, International Society of Paediatric Oncology (SIOP)
Although therapeutic progress is constantly creating new hope, there are still endemic health inequalities. The disparity evident between the North and South is also reflected in the widening inequity inside wealthier countries.
Urgency inevitably focuses on the poor. But to make an effective impact, we must improve on a stepwise approach. We need to go beyond just the symptoms and focus on the causes if we want to truly address social and personal vulnerability. This means identifying the roots of the fragile, endangered life journeys of the vulnerable individuals and families that we encounter. Anticipating and understanding the factors that impact on effective interventions is necessary, so we can act with direct benefit.
To reverse the inequality curve, we advocate for a comprehensive approach to each individual. This includes treating, educating, housing, informing, protecting and reintegrating those in need. We are working to provide comprehensive and inclusive support, which is the only guarantee of a newfound autonomy that can put these families back on the path towards hope. Based on conviction and pragmatism, this approach is now being widely shared, and we are stimulating the creation of an entire ecology of civil society actors from private, institutional, political and other systems who are used to working sector by sector. We also continue to deal with difficult and sometimes neglected issues, such as childhood cancer in poor countries or support for migrants. As always, everywhere we look we seek out effective and lasting collective remedies.
In line with international or national initiatives that combine multiple approaches and foster more integrated innovation, we are expanding the boundaries of our action to maximize impact. These new dynamics are creating an innovative form of more responsible and forward-looking sponsorship that is stimulating collaboration and solidarity. Once again, there is greater strength in unity.
The Sanofi Espoir Foundation was created in October 2010 by Sanofi to consolidate more than 20 years of commitment to national and international solidarity
The Sanofi Espoir Foundation’s mission is to contribute to reducing health inequalities among populations that need it most by applying a socially-responsible approach. Its commitment is focused on three key targets:
- Supporting mothers and unborn children in low- and middle-income countries (LMICs); 2.5 million children die each year during their first month of life (World Health Organization, 2020), to which another 2.6 million stillbirths must be added, mostly in these settings (World Health Organization, 2020a).
- Supporting children with cancer in LMICs; only 20% of children with cancer in certain LMICs will recover, against 80% in most high-income countries (Ward et al., 2019). Cancer is a leading cause of death among children worldwide (World Health Organization, 2020b).
- Accompanying the life journeys of the most vulnerable communities in France; poverty is not declining in France and the country is still creating highly challenging conditions for young people. (Institut Nacional de la Statistique et de Études Économiques, 2020)
The Foundation naturally responds to humanitarian emergencies, but focuses primarily on long-term partnerships to act on recurrent issues such as healthcare professional education and clinical training, disease prevention and access to care.
Supporting children with cancer in low- and middle-income countries
Giving every child an equal chance of survival
Cancer is one of the major causes of death in children. While the survival rate for many childhood cancers is 80% in resource-rich countries, this can fall to less than 20% in some resource-limited countries. The main reasons are poor access to diagnosis and appropriate treatment, scant numbers of trained healthcare personnel and high rates of treatment abandonment, often due to financial constraints.
A collective approach throughout the health journey
Care provision involves the key steps of access to information, diagnosis, treatment and supportive care. From 2005, through our My Child Matters programme, our awardees have tackled all of these issues to improve the chances of a cure. We are particularly proud to have helped provide the first stem cell transplant for a four-year-old girl in Paraguay.
In paediatric oncology, care is based on a multidisciplinary response backed by networking. Appropriate care is a health journey that must take account of the specific conditions in each country. We are supporting projects around ‘Six Themes’ all recognized as key to sustainably improving the conditions of children and adolescents living with cancer:
- cancer registries;
- professional education and training/capacity-building;
- early detection;
- supportive care and pain control;
- access to care;
- addressing treatment abandonment.
To date, together with our partners, we are proud of the significant results we have achieved – 30,000+ child/adolescent beneficiaries and 90,000+ healthcare professionals trained. In several countries the impact of this initiative has been highlighted in publications in prestigious journals such as The Lancet Oncology (Howard et al., 2018).
What’s new? What’s next?
The challenges of childhood cancer care in LMICs remain significant.
The vast majority (90%) of the world’s children live in LMICs and the inequalities are huge compared to those in high-income countries. In low- and lower-middle-income countries, “children with cancer are about four times more likely to die of the disease than children in high-income countries” (WHO 2020b).
As Dr Tedros, WHO Director-General, said, “…survival rates in poor countries are scandalously lower than those in wealthy countries” (WHO 2020b). To tackle these inequalities, in 2018, WHO launched the Global Initiative for Childhood Cancer (WHO 2020b). Our Foundation is strongly committed to this goal and is increasingly focused on low- and lower-middle-income countries. Through our LMIC strategy, we are committed to strengthening our programme in Africa and South East Asia where the vast majority of health inequalities are located. We act with our partners on all levels to efficiently and sustainably improve life conditions and the survival rate of children and adolescents with cancer.
We are currently supporting 34 active projects; 10 new projects were funded in 2020 in low- and lower-middle-income countries, which now represent two-thirds of our total budget allocation. With 14 projects in Africa and 8 projects in Asia, we are focusing on the most vulnerable regions and support our partners with their roadmaps, especially in pilot countries engaged in the WHO Global Initiative for Childhood Cancer (e.g., Myanmar, Peru, Ghana and Morocco).
We are working with our partners to strengthen regional networks and reference centres.
The following examples illustrate this specific approach:
1. Two pathology reference centres in sub-Saharan Africa
The development of two reference centres for pathology is based on a twining approach between Accra and Dakar, with a roadmap phased over the next 4-5 years. The two cities will act as hubs for the West Africa sub-region, covering both French- and English-speaking countries, and will benefit from equipment, support and expertise by:
- sharing state-of-the-art techniques;
- developing a network using common tools like i-PATH;
- sharing experiences and expertise with second-opinion diagnosis;
- training pathologists.
Both objectives aim to ensure:
- the permanent availability of appropriate and well-maintained equipment, practice and knowledge throughout the region;
- and an economic rationale for efficiency and sustainability.
The projects are structured under a strong country ownership model that we believe is key to ensuring appropriate buy-in and long-term viability. The two projects are locally driven. The Dakar project is run as a federation of three major hospitals and the University of Cheikh Anta Diop (UCAD), and the Accra project is the responsibility of the University of Ghana’s Medical School’s Pathology Department.
In addition to My Child Matters, both projects are strongly supported by highly-committed international partners, such as the Alliance Mondiale Contre le Cancer (AMCC) for Dakar and St Jude Children’s Research Hospital for Accra.
2. African School of Paediatric Oncology
Sustainable development cannot be achieved without a strong capacity-building programme for healthcare professionals. Of course, this is a long-term approach. In 2012, the French African Paediatric Oncology Group (GFAOP) established the African School of Paediatric Oncology (EAOP), with two universities and permanent support from My Child Matters.
This is a comprehensive training and certification programme in paediatric oncology for French-speaking African countries. To date, impressive results have been published (Hessissen et al, 2019), with a rapid increase in the pool of qualified paediatric oncology professionals in the region.
In 2020, a new set of training modules on pathology and diagnosis on an e-learning platform, in connection with the Reference Centre project in Dakar, is being developed with My Child Matters’ support. This new tool is designed to reach both pathologists and physicians in order to develop a common language of fundamentals to ease, improve and finally speed up communication during the diagnosis process.
3. The My Child Matters Nursing Awards
Building on the successful My Child Matters funding programme for children and adolescents with cancer in LMICs launched in 2006, at the 2015 International Society of Paediatric Oncology (SIOP) Congress in Toronto, the Sanofi Espoir Foundation announced a new initiative: My Child Matters funding for nurses in these settings in collaboration with SIOP.
In 2015 and 2016, My Child Matters nursing grants of €5,000 for 10 projects were awarded. In 2018–2019, this was modified to a €10,000 biennial grant for five projects, since it was noted that one year was too short to complete most projects, so we adjusted the grant to to give €10,000 to just five awardees for a 2-year project instead.
Grant applications are advertized on the SEF and SIOP websites and social media. Applicants are requested to develop and highlight innovative approaches to nursing service and practice that improve the care and quality-of-life of children and adolescents with cancer by focusing on education, professional practice or research. Expert paediatric oncology nurses review and score applications accepted in English and French. Initially, applications were accepted from all LMICs, however, since 2018, eligibility has been restricted to lower-middle and low-income countries due to the demand.
In 2015, 36 eligible applications were received and 27% were awarded a grant. A total of 60% of funded projects were in lower-middle or low-income countries. In 2016, 26 eligible applications were received and 37% were awarded a grant. Again, 60% were in lower-middle or low-income countries. The 2018–2019 call for new projects produced 61 eligible applications from 33 countries. Despite the good quality of the projects, only 8% (five nurses) were awarded a grant. In total, 90% of projects that have been supported from 2015–2019 were successfully implemented. Incomplete grants had significant local nursing personnel or national political issues.
Two changes were made for the 2020 call for nursing projects to increase our impact on childhood cancer in regions that need it most. The Foundation continued its focus on low- and lower-middle-income countries only and doubled its support to €100,000 in total to be shared among awardees in honor of the WHO International Council of Nursing, Year of the Nurse. A total of 26 eligible applications were received, and 12 projects were funded, all in low- and lower-middle-income countries (three awardees received a share of one €10,000 grant).
Examples of My Child Matters nursing grants include projects to address the infection control education of nurses at the Indus Hospital in Karachi, Pakistan; a paediatric oncology nursing orientation programme in Jakarta, Indonesia; early cancer detection using an ambassador and mobile money transfer in northwest Cameroon; and a childhood cancer awareness programme across Vietnam. In many cases, the nursing projects included collaboration with local and national nursing organizations, schools of nursing, non-governmental organizations and other critical stakeholders.
The Sanofi Espoir Foundation have awarded 37 nursing grants since the creation of the My Child Matters nursing awards in 2015 and sponsored 16 nurses over the last four SIOP congresses for project presentations. We believe that in-person presentations at SIOP serve to inspire other nurses and demonstrate best practices in a variety of resource-limited settings.
As one of the few supporters of paediatric oncology nursing care in LMICs, the Sanofi Espoir Foundation, in partnership with SIOP, has shown leadership in the improvement of nursing care for the 90% of children and adolescents with cancer who live in resource-poor areas around the world. The nurses who have received funding have highlighted the wide range of nursing practice areas for improvement and demonstrated that positive change is possible in the quality of life of patients and their families they attend. One nurse awardee from Tanzania notes:
“There has been a lot of success that has been observed throughout the process. One was to be able to bring together regional and district medical officers and nursing officers, TANNA (Tanzania National Nurses Association) regional branch leaders and hospital management teams around the same table to discuss the situation of childhood and adolescent cancer in our country particularly in the Southern Highland Zone. This action provided a strong gateway for the implementation of the proposed activities. There was positive collaboration between the stakeholders and the project team. A sense of ownership of the project was developed with the stakeholders, as was observed in the mid-evaluation whereby every hospital visited had a supportive environment for the project. Nurses work in different hospital departments where they contribute to more than 60% of the health work force and had a great opportunity to interact with the community, especially in providing health education and in creating awareness of childhood and adolescent cancer.” Elianeth Anande Kiteni – Tanzania – MCM Nurse awardee 2018 in her final report).
An oral presentation was given at SIOP 2020 entitled, “History and outcomes of the paediatric oncology nursing awards from the My Child Matters programme, an initiative of the Sanofi Espoir Foundation 2015–2020”. Moreover, a recent qualitative evaluation study, led by SIOP and the Sanofi Espoir Foundation explored the experiences and the perceived impact of four selected My Child Matters nursing award projects in El Salvador, Central African Republic, Indonesia and Tanzania. Interviews were performed with multiple stakeholders and the results will be published in a report and submitted to international scientific journals.
We will launch the sixth call for projects for the My Child Matters Nurses Awards in December 2021 and are looking forward to the applications, especially from nurses in low- or lower-middle-income or a French-speaking African country. If you are interested in submitting your project, watch our website for guidelines and deadlines: https://www.fondation-sanofi-espoir.com
Sanofi Espoir Foundation – 114 Rue La Boetie, 75008 PARIS, France
Hessissen L et al. “African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa.” Journal of global oncology 5 (2019): 1-12.
Howard SC et al. “The My Child Matters programme: effect of public–private partnerships on paediatric cancer care in low-income and middle-income countries.” The Lancet Oncology 19.5 (2018): e252-e266.
Institut Nacional de la Statistique et de Études Économiques (2020). Half of the people arrived in France in 2017 were born in Europe. Jérôme Lé INSEE FOCUS No 145 published 20/02/2019. https://www.insee.fr/en/statistiques/4214556 Accessed November 9, 2020
Ward ZJ, Yeh JM, Bhakta N, Frazier AL, Girardi F, Atun R. Global childhood cancer survival estimates and priority-setting: a simulation-based analysis. The Lancet Oncology. 2019 Jul 1;20(7):972-83.
World Health Organization (2020). Newborn health. https://www.who.int/health-topics/newborn-health/#tab=tab_1 Accessed, 9 November 2020.
World Health Organization (2020a). Maternal, newborn, child and adolescent health.