Why Cervical Cancer Elimination Needs a Regional Approach

Across Bhutan, Cambodia, Indonesia, and the Philippines, countries face increasingly complex fiscal environments shaped by declining global aid, pandemic recovery, extreme weather pressures, and competing development priorities.

The 5Cs capital stack (country spending, concessional lending, consumer spending, catalytic grant capital, and commercial investment) provides a framework for mobilizing diverse financing sources.

Relying on a single stream is economically fragile; blended finance can combine different sources of capital to support scaling up diagnostics, vaccination, and other components of cervical cancer elimination.

Financing the entire care pathway
While HPV DNA testing has addressed the technological diagnostic bottleneck, financing must extend beyond the test itself to services needed to complete the care pathway.

Costing models must include:

• Screening/HPV counseling
• Laboratory and sample transport systems
• Digital registries and health information systems for patient navigation
• Workforce training and task shifting
• Treatment devices (thermal ablation, loop electrosurgical excision procedure) closer to primary health facilities
• Operational costs for follow up and triage

Accurate costing in low- and middle-income countries requires balancing top down macro budgeting with bottom up micro costing. The Elimination Planning Tool (EPT) developed by the International Agency for Research on Cancer and the University of Sydney enables dynamic modeling of 10 year investment scenarios.

Domestic resource mobilization
Domestic resource mobilization for cervical cancer elimination requires ministries of health to demonstrate clear economic returns and secure government resources. Ministries of finance respond to evidence showing that cervical cancer prevention is a high yield merit good.

HPV vaccination and screening generate both private and social benefits, and demand is highly elastic—any increase in out of pocket costs sharply reduces uptake. This makes government financing essential.

Evidence based financing requires interoperable digital systems. Systems such as Indonesia’s SATUSEHAT and Bhutan’s regional Evidence Based Management Information Systems can help with tracking commodities, monitoring patient outcomes, and demonstrating return on investment to finance ministries. Without reliable data, future budget allocations stall.

Regional demand aggregation
Fragmented procurement, such as small-volume and unpredictable orders placed by decentralized units, can drive up landed costs through distributor markups, customs duties, and supply chain friction. Countries lack bargaining power when negotiating individually.

Regional demand aggregation can address this fragmentation by creating a larger and more predictable demand signal.

By signaling multi-year demand for millions of tests, countries can better secure global access pricing or more competitive all-inclusive pricing. Understanding market shaping mechanisms used in HIV viral load testing (achieving 30% price reductions) can help inform similar approaches for HPV diagnostics.

Even without organized pooled procurement mechanisms, coordinated demand forecasting and harmonized regulatory standards can reduce costs and strengthen regional bargaining power.

A proposed Coalition of Willing Countries offers a practical model for regional cooperation. Its potential benefits include joint demand forecasting, coordinated procurement communications, harmonized regulatory standards, shared training centers in Thailand and Viet Nam, reduced duplication of donor investments, and cross-border continuity of care for migrant populations.

Regional cooperation can support smaller countries in negotiating better prices and accessing shared expertise.

Universal health coverage and insurance reform
Historically, limited funding for prevention and greater focus on late stage treatment have placed a heavier financial burden on households and contributed to unequal access to care.

Countries must ring fence insurance revenues for preventive care to ensure resources are available for prevention. Thailand’s free HPV self sampling, Indonesia’s Cek Kesehatan Gratis, and the Philippines’ YAKAP capitation model illustrate scalable approaches.

Public insurance pools offer reduced information asymmetry and adverse selection, making universal health coverage a viable vehicle for elimination. Reorienting financing toward screening and accessible diagnostics is both economically efficient and socially equitable.

Workforce and digital capacity
Workforce shortages, particularly of specialists, remain a major barrier. Bhutan’s success with task shifting demonstrates that nurses and primary care workers can safely deliver screening and treatment.

Digital tools and AI assisted colposcopy can improve quality and expand access in underserved areas.

Six blended finance instruments have been identified as viable options for Southeast Asia, addressing different financing needs across cervical cancer prevention and care:

• Catalytic philanthropic anchors can reduce early risk for government and development banks’ participation. These anchors can support initial studies, procurement, and scale-up planning.
• MDB risk sharing instruments for service delivery can support early financing by providing capital at lower risk and lower cost and enable governments to invest in scale-up efforts without early budget shocks.
• Outcome based contracts (development impact bonds) can be financed early by investors and paid by governments only after the outcomes are achieved.
• Market shaping for diagnostics (pooled demand aggregation) can aggregate demand through formal or informal regional platforms.
• Earmarked health taxes (e.g., the Philippines’ taxes on tobacco and alcohol for universal health coverage and cancers) provide predictable domestic funding for cervical cancer prevention and treatment.
• Pooled blended health funds (e.g., EPICC Indo Pacific Fund) provide a vehicle to consolidate and coordinate multiple financing sources and investments.

These instruments provide options for moving beyond fragmented grants toward sustainable, systems-level financing for cervical cancer elimination.

The analysis points to several areas for action:

• Adopt blended financing models using the 5Cs capital stack.
• Mobilize domestic resources by presenting return on investment evidence to ministries of finance.
• Finance full care pathways based on system costings rather than isolated commodities.
• Implement coordinated demand forecasting and explore regional volume guarantees.
• Expand self-sampling, task shifting, and digital registries to accelerate coverage.
• Integrate HPV testing and treatment into national insurance benefit packages.

Note: Health leaders from the Philippines’ Department of Health and the ministries of health from Bhutan, Cambodia, and Indonesia, along with representatives from international development banks, global health agencies, philanthropic organizations, and technical partners discussed the issue during the Financing the Future of Cervical Cancer Elimination in Southeast Asia.