Tag Archives: cancer control

Uganda says “we can” on World Cancer Day

Guest blogger – Esther Nakkazi, freelance science journalist

Guest blogger – Esther Nakkazi, freelance science journalist

“We can – I can – get involved in cancer prevention and control”

This is the theme for World Cancer Day being promoted by Ugandan health ministry.

And this year it seems that the government is not just talking the talk, it is walking the walk with plans to provide the legal basis and funding to support a comprehensive approach to cancer control in the country.

When the 10th Parliament convenes after the May elections, the Cancer Bill will be high up on the agenda.

Its primary objective will be to establish the Uganda Cancer Institute as an autonomous agency of Government mandated to undertake and coordinate the prevention and treatment of cancer and cancer-related diseases and conduct research.

With only 25 oncologists in the whole country, Uganda currently struggles to care for the almost 30,000 people who are diagnosed with cancer every year. Speaking at a press conference at the Ministry of Health ahead of World Cancer Day, Jackson Orem, Director of the Uganda Cancer Institute, spoke of his hope of increasing survival from the current rate of 20% to 50%, through improved prevention, earlier detection and care. And he sounded confident the proposed measures would be debated as planned. “The Cancer Bill is already before the committee of health. It will be their priority in the next parliament,”he said.

With 60% of new cancer cases caused by infections, immunisation programmes will be key to cutting new cases. Cervical cancer, associated with infection with the HPV virus, is the single biggest cause of cancer death among women, with Kaposi sarcoma, associated with HIV infection, and liver cancer, associated with hepatitis also major killers.

Anthony Mbonye, the commissioner for community health services at Uganda’s Health Ministry, spoke of the government’s commitment to vaccination programmes. “Human Papilloma Virus (HPV) vaccination against cancer of the cervix is now available across the country and girls aged 10 years can access it in all our health facilities,” he said, adding that the Hepatitis B vaccine is now part of the routine childhood immunisations, and vaccination is also available for adults in high-burden districts, and will soon be available across the country.

As an autonomous agency, the Uganda Cancer Institute will be a corporate body governed by a Board of Directors. The Bill spells out that the Institute will undertake and coordinate the prevention and treatment of cancers in Uganda, including providing comprehensive medical care services to patients affected with cancer and other cancer-related diseases, and coordinating cancer-related activities both within and outside Uganda.

The Bill also provides for the Institute to conduct on-the-job training in oncology and related fields for its staff as well as to provide public education and training on cancer.

Importantly it includes provisions for funding the Institute and its work.

Orem hopes this will be an important step to establishing a truly national cancer service. “We want every cancer patient to be diagnosed and followed up. We need to get their contacts so that they are always within our systems,” he said.

But his aspirations go beyond Uganda’s own borders. “The UCI,” he said, “will be the centre for training oncologists in East Africa in an effort to increase human resource in the region.

Grand opening of the new Ugandan Cancer Institute buildings May 2015

Grand opening of the new Ugandan Cancer Institute buildings May 2015

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Speeding up global access to detection and care

 

Dr Rengaswamy Sankaranarayanan

Dr Rengaswamy Sankaranarayanan

Rengaswamy Sankaranarayanan, special advisor on cancer control and head of early detection and prevention at IARC (the WHO’s International Agency for Research on Cancer), Lyon, will lead the session on Access to effective and affordable treatments in middle- and low-income countries at the World Oncology Forum, Lugano, October 23–25. In this guest blogpost he talks about the policy recommendations he will be arguing for.

I’M LOOKING FORWARD to speaking at the World Oncology Forum about new healthcare financing models that are extending access to effective early diagnosis and treatment of cancer in many low- to- middle-income countries. I would like to see the Forum issue recommendations that can catalyse the pace of this transformation and deliver a very blunt message to governments and international development agencies.

Some success stories

The last few years have seen important progress in access to healthcare, particularly in middle-income countries. I would like to see this replicated in low-income countries.

Thailand, for instance, started introducing universal healthcare from 2002. Today, anyone living anywhere in Thailand, can access care seamlessly across public health services.

Initially under the Thai scheme, people were required to make a single, small copayment – 30 Baht or around $1 – the first time they see a healthcare professional for a particular complaint. That payment would cover the entire journey that follows, including diagnostic tests, treatments and follow-up. This co-payment was abolished in 2007, and universal health care became free for poor people.

Despite initial fears that the health system would collapse, it is working well. One important reason is that the government is investing a substantial amount of its GDP into healthcare. Another is that the “30-Baht” scheme mainly covers people from the very poorest rural communities – those employed by the government and the private sector have their own insurance systems.

Not only has it considerably improved access to healthcare in Thailand, it has also regulated the market, because the system will only pay for standard procedures. Since then, many other middle-income countries have implemented successful schemes to widen access to healthcare, including Turkey, India and Malaysia as well as many of the larger countries in Latin America, such as Mexico, Brazil, Colombia, Peru, Argentina and Chile.

Spreading the success: two recommendations

1. Cancer control must be a national responsibility

Countries like Thailand have shown it is possible through a variety of models to provide sustainable good-quality health services on a subsidised basis for a large proportion of people, while recovering healthcare costs from those who can afford it.

However, we also need to learn from our failures. In sub-Saharan Africa, for instance, health services have barely improved, there are no health financing systems, and access to healthcare has not improved at all.

I think one of the major reasons for this is the amount of external assistance they receive, which has blunted internal investment and internal drive and internal planning.

We need to make governments realise that healthcare is their own responsibility, and the systems and investments they have to make should be their own, and should come from their own national budgets. The way to do this is to substantially increase the GDP proportion that is contributed to healthcare from national budget.

So one message I would like to come out of the World Oncology Forum is that:
International organisations and funding agencies should insist that the countries they help must predominantly use national resources to develop and sustain their own national healthcare services.

 2. Cancer control needs a joined up approach

Another lesson we need to learn is that countries need to approach cancer control as a whole, linking prevention, early detection, treatment and palliative care. In Latin America, for instance, screening with the Pap smear was carried out for many many years, with very little impact on disease. Everyone blamed the poor cytology, but the bigger problem was that most women with the positive cytology never had a diagnosis made and never received treatment.

Governments and international agencies need to take a more comprehensive view across the entire spectrum of cancer control.

I think we have lessons to learn here from the comprehensive approach taken by the GAVI alliance, which has been very successful in terms of immunisation coverage and reducing child mortality. So another key message I would like to see coming out of the World Oncology Forum is:
We need to think in terms of a global alliance for cancer care continuum.

 Other key issues

Other key issues I will be asking the World Oncology Forum to consider include:

  • The urgent need to secure universal access to basic early diagnosis and treatment services
  • Opportunities for working within the wider efforts to tackle “non-communicable diseases”
  • Reversing the worrying trend towards adopting expensive and unnecessary imaging investigations, very expensive, very high-tech radiotherapy equipment and techniques, and expensive chemotherapy regimens and targeted drugs whose additional benefit has not been well demonstrated.

I look forward to the discussion

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