Regional workshop on scaling up services for cancer and implementing South-East Asia Cancer Grid

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.sf-search-input-wrapper{padding-left:24px}.right-to-left .srchaction{padding-right:24px;padding-left:0}.ui-autocomplete.ui-front.sf-autocomplete{z-index:999}.right-to-left #sf-top-header span.srchaction{padding-left:0;padding-right:24px}span.srchtoggle{z-index:3}#sf-top-header .srchaction-wrapper{display:flex;opacity:0;transition:.3s all ease;width:0;height:48px}.search-open #sf-top-header .srchaction-wrapper{width:280px;opacity:1}#sf-top-header span.srchtoggle{display:block!important;opacity:1;transition:1s opacity ease}.search-open #sf-top-header span.srchtoggle{transition:.3s opacity ease;opacity:0}.language-selector{z-index:4} #sf-top-header .srchaction-wrapper { overflow: hidden; }</style><meta property="og:title" content="Regional workshop on scaling up services for cancer and implementing South-East Asia Cancer Grid" /><meta property="og:description" content="In 2022, World Health Organization (WHO) South-East Asia Region had an estimated 2.4 million new cases of cancer including 56,000 children. Cancers of breast, cervix and lung were the most common cancers. The region had the highest rate of incidence for cancer of lips and oral cavity. The number of deaths due to cancer was 1.5 million in the region, an increase by almost one third compared to ten years before. Moreover, the number of new cases and deaths due to cancer in the region are estimated to increase further by over 85% by the year 2050.Programs on reducing risk factors have been effectively implemented in the countries, however, persistent challenges exist in access to management of cancers. Almost half of the childhood cancers are estimated to remain undiagnosed; cancer treatment centres are mostly overburdened with patients; and mortality to incidence ratio for cancers is almost double that for high income countries. Cancer services are included in health benefit packages in only six countries.Scaling up the services for cancers requires coordinated multiprong actions in defined order of priorities from government and partners. To facilitate collaboration in capacity building, SEARO has established the WHO South-East Asia Cancer Grid (SEACanGrid), a network of tertiary care institutions, in collaboration with the WHO collaborating centre for cancers Tata Memorial Hospital Mumbai.In this backdrop, the WHO South-East Asia regional workshop on improving services for cancer and implementing the South-East Asia Cancer Grid was organized with participation of key service provider institutions, country policy makers and programme managers, and global and regional leaders in cancer care along with partners with the objective of supporting countries in scaling up services for cancer with optimal financing.Among other things, the workshop discussed on the regional strategy on cancer prevention and management; mobilizing resources for cancer care; priorities on screening, diagnosis, treatment; and strengthening cancer registries. The workshop also launched the South-East Asia Cancer Grid.The workshop emphasized some critical aspects that the countries should consider that when planning scaling up cancer services. When faced with resource constrains, prioritization must be done to address the diseases and interventions with high value for the investment. For cancers other than that of uterine cervix, the decision to adopt a population-based screening approach should be based on country specific disease burden, availability of resources and the priority needs. Where resources are limited, investing in early diagnosis provides more gains compared to investing in screening. Strong referral networks and availability of treatment facility should be ensured when interventions for early detection are planned. Priority should be given in strengthening treatment services for diseases with relatively good outcome with low-cost generic medicines and interventions such as childhood cancer. Palliative care services have to be strengthened in all levels of health care facilities with focus on delivery through primary health care. Major portion of the investment on cancer services may be used for availing human resources. Investing in state-of-the-art equipment with no or suboptimal investment in availing the required human resource is an improper use of resources. Collaboration among service providers helps amplify the efforts on scaling up services for cancer. The workshop called on governments and cancer service provider institutions to utilize and contribute to the SEACanGrid platform. Innovative approaches can be introduced to increase the fiscal space for cancer some of which include taking advantage of increasing GDP where such scenario exists, health sector specific taxes such as in sugary beverages, voluntary solidarity levy, advanced market commitment etc. Cancer registry development should be included as part of national cancer control plans and resources be dedicated to increase quality and coverage of population-based cancer registries.Based on these, the country teams worked on developing country-specific pathways in implementing priority interventions for scaling up services for cancer in the next few years.The proceedings and outcome are summarized in the workshop report." /><meta property="og:image" content="https://www.who.int/images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-1200v.jpg?Culture=en&sfvrsn=db1a2d9_6" /><meta name="description" content="In 2022, World Health Organization (WHO) South-East Asia Region had an estimated 2.4 million new cases of cancer including 56,000 children. Cancers of breast, cervix and lung were the most common cancers. The region had the highest rate of incidence for cancer of lips and oral cavity. The number of deaths due to cancer was 1.5 million in the region, an increase by almost one third compared to ten years before. Moreover, the number of new cases and deaths due to cancer in the region are estimated to increase further by over 85% by the year 2050.Programs on reducing risk factors have been effectively implemented in the countries, however, persistent challenges exist in access to management of cancers. Almost half of the childhood cancers are estimated to remain undiagnosed; cancer treatment centres are mostly overburdened with patients; and mortality to incidence ratio for cancers is almost double that for high income countries. Cancer services are included in health benefit packages in only six countries.Scaling up the services for cancers requires coordinated multiprong actions in defined order of priorities from government and partners. To facilitate collaboration in capacity building, SEARO has established the WHO South-East Asia Cancer Grid (SEACanGrid), a network of tertiary care institutions, in collaboration with the WHO collaborating centre for cancers Tata Memorial Hospital Mumbai.In this backdrop, the WHO South-East Asia regional workshop on improving services for cancer and implementing the South-East Asia Cancer Grid was organized with participation of key service provider institutions, country policy makers and programme managers, and global and regional leaders in cancer care along with partners with the objective of supporting countries in scaling up services for cancer with optimal financing.Among other things, the workshop discussed on the regional strategy on cancer prevention and management; mobilizing resources for cancer care; priorities on screening, diagnosis, treatment; and strengthening cancer registries. The workshop also launched the South-East Asia Cancer Grid.The workshop emphasized some critical aspects that the countries should consider that when planning scaling up cancer services. When faced with resource constrains, prioritization must be done to address the diseases and interventions with high value for the investment. For cancers other than that of uterine cervix, the decision to adopt a population-based screening approach should be based on country specific disease burden, availability of resources and the priority needs. Where resources are limited, investing in early diagnosis provides more gains compared to investing in screening. Strong referral networks and availability of treatment facility should be ensured when interventions for early detection are planned. Priority should be given in strengthening treatment services for diseases with relatively good outcome with low-cost generic medicines and interventions such as childhood cancer. Palliative care services have to be strengthened in all levels of health care facilities with focus on delivery through primary health care. Major portion of the investment on cancer services may be used for availing human resources. Investing in state-of-the-art equipment with no or suboptimal investment in availing the required human resource is an improper use of resources. Collaboration among service providers helps amplify the efforts on scaling up services for cancer. The workshop called on governments and cancer service provider institutions to utilize and contribute to the SEACanGrid platform. Innovative approaches can be introduced to increase the fiscal space for cancer some of which include taking advantage of increasing GDP where such scenario exists, health sector specific taxes such as in sugary beverages, voluntary solidarity levy, advanced market commitment etc. Cancer registry development should be included as part of national cancer control plans and resources be dedicated to increase quality and coverage of population-based cancer registries.Based on these, the country teams worked on developing country-specific pathways in implementing priority interventions for scaling up services for cancer in the next few years.The proceedings and outcome are summarized in the workshop report." /><meta name="twitter:card" content="summary_large_image" /><link rel="canonical" href="https://www.who.int/southeastasia/activities/scaling-up-services-for-cancer-and-implementing-south-east-asia-cancer-grid" /><meta name="description" content="In 2022, World Health Organization (WHO) South-East Asia Region had an estimated 2.4 million new cases of cancer including 56,000 children. Cancers of breast, cervix and lung were the most common cancers. The region had the highest rate of incidence for cancer of lips and oral cavity. The number of deaths due to cancer was 1.5 million in the region, an increase by almost one third compared to ten years before. Moreover, the number of new cases and deaths due to cancer in the region are estimated to increase further by over 85% by the year 2050.Programs on reducing risk factors have been effectively implemented in the countries, however, persistent challenges exist in access to management of cancers. Almost half of the childhood cancers are estimated to remain undiagnosed; cancer treatment centres are mostly overburdened with patients; and mortality to incidence ratio for cancers is almost double that for high income countries. Cancer services are included in health benefit packages in only six countries.Scaling up the services for cancers requires coordinated multiprong actions in defined order of priorities from government and partners. To facilitate collaboration in capacity building, SEARO has established the WHO South-East Asia Cancer Grid (SEACanGrid), a network of tertiary care institutions, in collaboration with the WHO collaborating centre for cancers Tata Memorial Hospital Mumbai.In this backdrop, the WHO South-East Asia regional workshop on improving services for cancer and implementing the South-East Asia Cancer Grid was organized with participation of key service provider institutions, country policy makers and programme managers, and global and regional leaders in cancer care along with partners with the objective of supporting countries in scaling up services for cancer with optimal financing.Among other things, the workshop discussed on the regional strategy on cancer prevention and management; mobilizing resources for cancer care; priorities on screening, diagnosis, treatment; and strengthening cancer registries. The workshop also launched the South-East Asia Cancer Grid.The workshop emphasized some critical aspects that the countries should consider that when planning scaling up cancer services. When faced with resource constrains, prioritization must be done to address the diseases and interventions with high value for the investment. For cancers other than that of uterine cervix, the decision to adopt a population-based screening approach should be based on country specific disease burden, availability of resources and the priority needs. Where resources are limited, investing in early diagnosis provides more gains compared to investing in screening. Strong referral networks and availability of treatment facility should be ensured when interventions for early detection are planned. Priority should be given in strengthening treatment services for diseases with relatively good outcome with low-cost generic medicines and interventions such as childhood cancer. Palliative care services have to be strengthened in all levels of health care facilities with focus on delivery through primary health care. Major portion of the investment on cancer services may be used for availing human resources. Investing in state-of-the-art equipment with no or suboptimal investment in availing the required human resource is an improper use of resources. Collaboration among service providers helps amplify the efforts on scaling up services for cancer. The workshop called on governments and cancer service provider institutions to utilize and contribute to the SEACanGrid platform. Innovative approaches can be introduced to increase the fiscal space for cancer some of which include taking advantage of increasing GDP where such scenario exists, health sector specific taxes such as in sugary beverages, voluntary solidarity levy, advanced market commitment etc. Cancer registry development should be included as part of national cancer control plans and resources be dedicated to increase quality and coverage of population-based cancer registries.Based on these, the country teams worked on developing country-specific pathways in implementing priority interventions for scaling up services for cancer in the next few years.The proceedings and outcome are summarized in the workshop report." /></head> <body class="sf-body "> <a class="visually-hidden-focusable" href="#content">Skip to main content</a> <noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-5QFSQRT" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><script 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class="sf-detail-body-container sf-detail-body-wrapper activity--detail dynamic-content dynamic-content__article"> <script type='text/javascript' src='/ResourcePackages/WHO/assets/dist/scripts/multimedia-modal.min.js?v=14.0.7729.19549'></script> <script type='text/javascript' src='/ResourcePackages/WHO/assets/dist/scripts/magnific-popup.min.js?v=14.0.7729.19549'></script> <script async defer src="https://connect.facebook.net/en_US/sdk.js#xfbml=1&version=v3.2"></script> <header class="dynamic-content__header dynamic-content__container"> <div class="sf-header-image dynamic-content__image dynamic-content__image" data-url=""> <div class="inner"> <a class="magnific-popup" href="/images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-1920v.jpg?Culture=en&sfvrsn=db1a2d9_6 1920w" title="WHO-SEARO Cancer workshop 2024"> <img sizes="(max-width: 479px) 280px, (max-width: 549px) 440px, (max-width: 768px) 660px, (max-width: 1366px) 1024px, 1920px" srcset="/images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-479v.jpg?Culture=en&sfvrsn=db1a2d9_6 479w, /images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-549v.jpg?Culture=en&sfvrsn=db1a2d9_6 549w, /images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-768v.jpg?Culture=en&sfvrsn=db1a2d9_6 768w, /images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-1024v.jpg?Culture=en&sfvrsn=db1a2d9_6 1024w, /images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-1366v.jpg?Culture=en&sfvrsn=db1a2d9_6 1366w, /images/default-source/searo---images/cancer/group-photo_workshop-proceedings.tmb-1920v.jpg?Culture=en&sfvrsn=db1a2d9_6 1920w" class="single-image" alt="Regional workshop on scaling up services for cancer and implementing South-East Asia Cancer Grid" /> </a> </div> <div class="sf-image-credit"> <div class="sf-image-credit__content"> <div class="sf-image-credit__inner"> WHO-SEARO <br />Cancer workshop 2024 </div> </div> <div class="sf-image-credit__label"> <span class="sf-image-credit__copyright">©</span> <span class="sf-image-credit__text">Credits </span> <i class="icon plus-icon"></i> </div> </div> <script> var imageCreditClass = document.getElementsByClassName("sf-image-credit"); var preventFunction = function () { event.preventDefault() }; for (var i = 0; i < imageCreditClass.length; i++) { imageCreditClass[i].addEventListener('click', preventFunction);; } </script> </div> <div class="dynamic-content__title"> <h1 class="dynamic-content__title-text" >Regional workshop on scaling up services for cancer and implementing South-East Asia Cancer Grid</h1> </div> </header> <section class="sf-body-detail container"> <div class="row"> <div class="sf_colsIn col-md-12"> <div class="row sf-content-detail"> <div class="sf_colsIn col-md-7"> <div class="large-body-font-size"> <p></p><p>In 2022, World Health Organization (WHO) South-East Asia Region had an estimated 2.4 million new cases of cancer including 56,000 children. Cancers of breast, cervix and lung were the most common cancers. The region had the highest rate of incidence for cancer of lips and oral cavity. The number of deaths due to cancer was 1.5 million in the region, an increase by almost one third compared to ten years before. Moreover, the number of new cases and deaths due to cancer in the region are estimated to increase further by over 85% by the year 2050.</p><p>Programs on reducing risk factors have been effectively implemented in the countries, however, persistent challenges exist in access to management of cancers. Almost half of the childhood cancers are estimated to remain undiagnosed; cancer treatment centres are mostly overburdened with patients; and mortality to incidence ratio for cancers is almost double that for high income countries. Cancer services are included in health benefit packages in only six countries.</p><p>Scaling up the services for cancers requires coordinated multiprong actions in defined order of priorities from government and partners. To facilitate collaboration in capacity building, SEARO has established the WHO South-East Asia Cancer Grid (SEACanGrid), a network of tertiary care institutions, in collaboration with the WHO collaborating centre for cancers Tata Memorial Hospital Mumbai.</p><p>In this backdrop, the <em>WHO South-East Asia regional workshop on improving services for cancer and implementing the South-East Asia Cancer Grid</em> was organized with participation of key service provider institutions, country policy makers and programme managers, and global and regional leaders in cancer care along with partners with the objective of supporting countries in scaling up services for cancer with optimal financing.</p><p>Among other things, the workshop discussed on the regional strategy on cancer prevention and management; mobilizing resources for cancer care; priorities on screening, diagnosis, treatment; and strengthening cancer registries. The workshop also launched the South-East Asia Cancer Grid.</p><p><img alt="" src="/images/default-source/searo---images/cancer/img_5549.jpg?sfvrsn=e4752225_2" sf-size="194362" /></p><p>The workshop emphasized some critical aspects that the countries should consider that when planning scaling up cancer services. When faced with resource constrains, prioritization must be done to address the diseases and interventions with high value for the investment. For cancers other than that of uterine cervix, the decision to adopt a population-based screening approach should be based on country specific disease burden, availability of resources and the priority needs. Where resources are limited, investing in early diagnosis provides more gains compared to investing in screening. Strong referral networks and availability of treatment facility should be ensured when interventions for early detection are planned. Priority should be given in strengthening treatment services for diseases with relatively good outcome with low-cost generic medicines and interventions such as childhood cancer. Palliative care services have to be strengthened in all levels of health care facilities with focus on delivery through primary health care. Major portion of the investment on cancer services may be used for availing human resources. Investing in state-of-the-art equipment with no or suboptimal investment in availing the required human resource is an improper use of resources. Collaboration among service providers helps amplify the efforts on scaling up services for cancer. The workshop called on governments and cancer service provider institutions to utilize and contribute to the SEACanGrid platform. Innovative approaches can be introduced to increase the fiscal space for cancer some of which include taking advantage of increasing GDP where such scenario exists, health sector specific taxes such as in sugary beverages, voluntary solidarity levy, advanced market commitment etc. Cancer registry development should be included as part of national cancer control plans and resources be dedicated to increase quality and coverage of population-based cancer registries.</p><p>Based on these, the country teams worked on developing country-specific pathways in implementing priority interventions for scaling up services for cancer in the next few years.</p><p>The proceedings and outcome are summarized in <span style="text-decoration:underline;"><a href="https://iris.who.int/bitstream/handle/10665/378069/SEA-NCD-108-eng.pdf?sequence=1">the workshop report</a></span>.</p><p></p> </div> </div> <div class="sf_colsIn col-sm-12 col-md-4 col-md-push-1"> </div> </div> </div> </div> </section> <section class="sf-related-detail container"> <div class="row"> <div class="sf_colsIn col-md-12"> </div> </div> </section> </article> <script type='text/javascript' src='/ResourcePackages/WHO/assets/dist/scripts/accordion-sidebar.min.js?v=14.0.7729.19549'></script> <script type="text/javascript"> (function () { new AccordionJS(); })(); function buildMagnificThumbnail() { let imgUrl = $('.magnific-popup').attr('href'); if ($(window).width() < 480) { imgUrl = imgUrl.replace(/1920/g, '479'); } else if ($(window).width() >= 480 && $(window).width() < 550) { imgUrl = imgUrl.replace(/1920/g, '549'); } else if ($(window).width() >= 550 && $(window).width() < 769) { imgUrl = imgUrl.replace(/1920/g, '768'); } else if ($(window).width() >= 769 && $(window).width() < 1367) { imgUrl = imgUrl.replace(/1920/g, '1024'); } else if ($(window).width() >= 1367 && $(window).width() < 1920) { imgUrl = imgUrl.replace(/1920/g, '1366'); } $('.magnific-popup').attr('href', imgUrl); } $(document).ready(function () { buildMagnificThumbnail(); $('.magnific-popup').magnificPopup({ type: 'image' }); }); </script> </div> </div> <div id="PageContent_T2ABBF108001_Col00" class="sf_colsIn container" data-sf-element="Container" data-placeholder-label="Container"><div class="row" data-sf-element="Row"> <div id="PageContent_T2ABBF108004_Col00" class="sf_colsIn col-md-12" data-sf-element="Column 1" data-placeholder-label="Body content 1"><div class="row" data-sf-element="Row"> <div id="PageContent_C023_Col00" class="sf_colsIn col-md-12" data-sf-element="Column 1" data-placeholder-label="Column 1"><div class="row" data-sf-element="Row"> <div id="PageContent_C026_Col00" class="sf_colsIn col-md-12" data-sf-element="Column 1" data-placeholder-label="Column 1"> <div class="section-heading"> <h2>Our work</h2> <a href="https://www.who.int/southeastasia/activities?healthtopics=b53e45fb-ead3-4f68-8055-79ebd41ec9e3,a80d353e-b41c-4939-a7f9-a9406e47f691&publishingoffices=36eb8f8b-b9d5-4073-83fa-00eeca1c63e9&regionscountries=6b64b787-ab26-49a4-a29e-08d24d367a05">All →</a> </div> <div class="list-view horizontal-list matching-height"> <div class="list-view--item horizontal-list-item matching-height--item"> <a href="https://www.who.int/southeastasia/activities/seacangrid" class="link-container" aria-label="SEACanGrid" role="link"> <div class="thumb"> <div class="background-image background-image--small" data-image="/images/default-source/searo---images/health-topics/noncommunicable-diseases/seacangrid_logo-1-08.tmb-768v.png?Culture=en&sfvrsn=aaafd58b_1" style="background-image: url('/images/default-source/searo---images/health-topics/noncommunicable-diseases/seacangrid_logo-1-08.tmb-549v.png?Culture=en&sfvrsn=aaafd58b_1')"></div> </div> <div class="info"> <div class="date"> </div> <p class="heading text-underline">SEACanGrid</p> </div> </a> </div> <div class="list-view--item horizontal-list-item matching-height--item"> <a href="https://www.who.int/southeastasia/activities/expanding-childhood-cancer-services" class="link-container" aria-label="Expanding childhood cancer services" role="link"> <div class="thumb"> <div class="background-image background-image--small" data-image="/images/default-source/searo---images/health-topics/noncommunicable-diseases/154_who-russia.tmb-768v.jpg?Culture=en&sfvrsn=13652453_1" style="background-image: url('/images/default-source/searo---images/health-topics/noncommunicable-diseases/154_who-russia.tmb-549v.jpg?Culture=en&sfvrsn=13652453_1')"></div> </div> <div class="info"> <div class="date"> </div> <p class="heading text-underline">Expanding childhood cancer services</p> </div> </a> </div> </div> <div class="section-heading"> <h2>Publications</h2> <a href="https://www.who.int/southeastasia/publications/i?healthtopics=d8468fea-d127-456f-8124-81a4aeaa978a&publishingoffices=25f67455-0fef-428e-b6df-5701cdbb776f">All →</a> </div> <div class="sf-publications"> <div class="sf-publications-list sf-publications-list__horizontal row"> <div class="sf-publications-item list-item col-sm-3"> <div class="sf-publications-item__container"> <figure class="sf-publications-item__figure"> <img src="/images/default-source/searo---images/cancer/cancer-strategy-doc.tmb-144v.jpg?Culture=en&sfvrsn=e6ce2397_1" alt="" /> </figure> <div class="sf-publications-item__body"> <div class="sf-publications-item__header"> <div class="sf-publications-item__date"> <span>12 September 2024</span> </div> <a href="/southeastasia/publications-detail/9789290211709"> <h3 class="sf-publications-item__title">WHO South-East Asia Regional Strategy for comprehensive cancer prevention and management 2024–2030</h3> </a> </div> <div class="sf-publications-item__description"> <p>In the WHO South-East Asia Region, 2.37 million new cases and 1.53 million deaths were estimated to be due to cancer in 2022. Moreover, the cancer burden... </p> </div> <div class="sf-publications-item__actions"> <div class="sf-publications-item__file"> <a class="download-url " href="https://iris.who.int/bitstream/handle/10665/378875/9789290211709-eng.pdf?sequence=1" aria-label="Download" target="_blank">Download</a> </div> <div class="sf-publications-item__url"> <a href="/southeastasia/publications-detail/9789290211709" class="page-url" aria-label="Read More">Read More</a> </div> </div> </div> </div> </div> <div class="sf-publications-item list-item col-sm-3"> <div class="sf-publications-item__container"> <figure class="sf-publications-item__figure"> <img src="/images/default-source/searo---images/cancer/regional-cancer-workshop-14-17-may2024.tmb-144v.jpg?Culture=en&sfvrsn=6b719e3d_1" alt="" /> </figure> <div class="sf-publications-item__body"> <div class="sf-publications-item__header"> <div class="sf-publications-item__date"> <span>26 June 2024</span> </div> <a href="/southeastasia/publications-detail/SEA-NCD-108"> <h3 class="sf-publications-item__title">Report of the WHO South-East Asia Regional workshop on scaling up services for cancer and implementing... </h3> </a> </div> <div class="sf-publications-item__description"> <p>In the background of rising burden of cancer in the region and the need for improving access to management of cancers, WHO organized the South-East Asia... </p> </div> <div class="sf-publications-item__actions"> <div class="sf-publications-item__file"> <a class="download-url " href="https://iris.who.int/bitstream/handle/10665/378069/SEA-NCD-108-eng.pdf?sequence=1" aria-label="Download" target="_blank">Download</a> </div> <div class="sf-publications-item__url"> <a href="/southeastasia/publications-detail/SEA-NCD-108" class="page-url" aria-label="Read More">Read More</a> </div> </div> </div> </div> </div> </div> </div> <div class="section-heading"> <h2>Related health topics</h2> </div> <div class="sf-content-block 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Regional workshop on scaling up services for cancer and implementing South-East Asia Cancer Grid