When you walk through cancer wards of public sector hospitals in Africa, the scenes are reminiscent of the battle to get AIDS treatment under way in the early 2000s. But now, hospital beds once filled with AIDS patients are occupied by those afflicted with cancers and other non-communicable diseases (NCDs).
NCDs are no longer exclusively problems associated with the well-off. Worldwide, roughly 75% of deaths from NCDs occur in low- and middle-income countries (LMICs). In Africa, NCDs are projected to account for roughly 40% of the disease burden by 2030. The costly, complex and/or chronic nature of many of these diseases will fuel the rise in health care costs, underscoring the importance of taking action now.
NCDs are the silent killers with insidious debilitating complications and premature deaths. Take cancer as an example. In 2012, approximately 645,000 new cancer cases and 456,000 cancer deaths occurred in Africa. With limited knowledge and awareness, most patients reach health facilities at an advanced stage of the disease, when the prognosis and survival prospects are dim. They travel long distances, make huge financial sacrifices, and often end up on waiting lists. The impoverishing effects of catastrophic health spending on cancer is a major concern. For example, in Kenya, chemotherapy ranges between $130 and $2000 per treatment in a country with a per capita GDP of $2776.
The situation is dire in places where health systems are ill-prepared and poorly financed. Only 5% of global cancer resources are spent in LMICs, which account for 80% of disability adjusted years of life lost to cancer. This disparity is expected to grow dramatically as changing lifestyles, increasing urbanization, and aging populations are projected to double the incidence of cancer in Africa in the next five years.
The capacity of public sector facilities in Africa to provide treatment outstrips the demand for these specialized services, and care at private facilities is beyond the means of most families. The majority of countries have only a handful of cancer specialists (i.e., oncologists, radiotherapists and pathologists), and access to costly medications, technologies and diagnostics is a major bottleneck. Programs to detect and diagnose cancers early are still at a nascent stage.
The situation is not all doom and gloom. First, the recently published second volume of the Disease Control Priorities, 3rd edition series, makes a compelling case for stepping up cancer control efforts and provides sound evidence on the most preventable cancers and the highly curable ones when diagnosed early. Second, lessons from HIV/AIDS can be brought to bear. The global community demonstrated how millions of lives could be saved by mobilizing financial resources, adopting task shifting, and negotiating reductions in the price of drugs and diagnostics. Third, important lessons and promising experiences are emerging from countries that have initiated cancer control efforts in Africa.
A recent World Bank Group South-South Knowledge Exchange brought together a group of stakeholders from Africa to share experiences, lessons, and good practices. Representatives from Botswana, Rwanda, and Zambia discussed how task shifting has been used to expand the role of nurses and community workers in the provision of selective cancer services and outreach activities. Participants learned about Rwanda’s successful scale-up of the HPV vaccination program targeting adolescent girls, and about Butaro Hospital, the first rural cancer facility in Africa which provides care and treatment and taps the potential of telemedicine.
A team from Uganda shared its unique population-based cancer registry, which provides critical information to planners, policymakers and researchers to better understand the burden of cancer and improve treatment options. Kenyan colleagues presented lessons from the country’s palliative care program which offers urgently need care for the terminally ill.
In addition, a visit to Lusaka provided an opportunity to learn how Zambia has successfully scaled up its cervical cancer program using visual inspection with acetic acid -- the “see and treat” method for immediate, cost-effective treatment of pre-cancerous lesions -- along with the innovative use of telemedicine for conducting quality assurance. Zambia has ambitious plans to develop into a center of excellence for women’s cancers in the Lusaka region- A specialized cancer hospital, now under construction, reflects growing demand for these services and the government’s bold vision to tackle these issues.
One noteworthy outcome of the knowledge exchange is a proposed pilot to strengthen surveillance and pathology services under the Bank-funded East Africa Public Health Laboratory Networking Project, leveraging existing investments and promoting use of multi-platform technologies, which focused initially on communicable diseases.
As we start a new year, health experts who work in Africa should consider several new priorities for preventing and treating cancer: 1) ensuring that cost-effective cancer interventions are progressively incorporated into universal health care coverage packages; 2) leveraging existing platforms and investments for cancer care and treatment; and 3) exploring how to better tap the capacity of the private sector.
We need to ensure that access to cancer care and treatment does not hinge on one’s socio-economic status. Just like AIDS, a cancer diagnosis should not be tantamount to a death sentence.
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Cancer care: A neglected area in global health?