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The National Cancer Control Plan to advance healthcare in Uganda
At secondary district-level facilities, imaging and tissue sampling can be performed in order to relieve the over-burdened UCI. PHOTOS | PROMISE TWINAMUKYE
What you need to know:
- Basic care such as educational programmes should be brought to community health centers, at which the majority of women first present with symptoms. At secondary district-level facilities, imaging and tissue sampling can be performed.
Cancer and particularly breast cancer is on steep increase according to Dr Joseph Kyaterekera, a general physician at C-Care Uganda, attributes the rise to a number of factors including increased awareness about the disease.He also remarks that, “There is considerable widespread of cancer cases, among the Nile basin communities due to the rampant pollution of the river, on the population is dependent.” Most of the people in Eastern and Northern Uganda depend on the Nile water which is full of toxins from industrial wastes.”
For every 100,000 women, 42 of them have breast cancer, according to Dr Kyaterekera and nearly one-half of Ugandan women who are diagnosed with breast cancer will die of the disease.
These high mortality rates can be attributed to a late stage at diagnosis. According to Uganda Cancer Society, up to 89 percent of women in Uganda present with stage III or stage IV disease, a time at which breast cancer is more difficult to treat and the outcomes are poor.
This is attributable to a dysfunctional referral system and a lack of recognition of the early signs and symptoms among primary health care providers, compounded by the poor infrastructure and inadequate human capacity.
The absence of a supportive policy environment has also affected coordinated interventions, which could help scale up service provision in the country, coupled with the slow pace at which regional cancer centers are being established.
The fight so far
Fortunately, the government has an agenda to build regional cancer centres to reduce the transport burden that people from far places have to suffer in order to get treatment from the Uganda Cancer Institute (UCI).
Regional cancer centres are being established in Mbarara for Western, Arua for West Nile, Gulu for Northern and Mbale for Eastern. The Gulu centre is ready with a new hospital complex and equipment, awaiting official launch. In Mbarara, there is a cancer unit already operating but providing minimal services.
There is an autonomous status for UCI to manage procurement of its own drugs, manage its operations, recruit and train staff. The UCI has new and advanced equipment and recruited new staff but the number is insufficient to manage the overwhelming numbers.
The challenges
In Uganda, the greatest challenges in cancer management include delays in getting diagnosis where people first self-medicate, go to small clinics or even herbalists while the cancer advances and by the time they get to hospital, it is too late to manage it.
Also, sometimes doctors delay in making decisions on whether to start the patient on cancer treatment, especially when the tests are inconclusive. There is scarcity of equipment for the overwhelming number of patients, according to Dr Kyaterekera and the investigations or treatment procedures take a lot of time. "For instance, there are only two radiotherapy machines and if a person queues up for a whole day but does not get treatment, they are discouraged from returning the next day,"he says.
Dr Kyaterekera says, “There is a need for political intervention because the number of patients is overwhelming but the consumables are not enough especially the drugs. Like it was with the fight against HIV, we need to scale up efforts against cancer.”
The World Health Organisation (WHO) recommends member states to have a national cancer control plan to streamline interventions and to guide national planning.
According to Dennis Olodi, the executive director Uganda Cancer Society, cancer interventions in Uganda are centralised, not properly coordinated, urban biased, inefficient, and not well aligned with the country’s cancer burden.
“Most cancer patients enter the care pathway by self-referral, due to alarming symptoms. The health system also suffers from weak infrastructure and insufficient human resources and financing, along with a lack of sufficient stakeholders’ participation,” Olodi notes.
The UCI is the government lead agency mandated by law (Uganda Cancer Institute Act 2016) to spearhead and coordinate all cancer control related efforts in the country.
As such, the Government of Uganda through the Ministry of Health and Uganda Cancer Institute is currently developing the National Cancer Control Plan (NCCP) to support efforts and streamline interventions towards cancer control.
Key components
The National Cancer Control Plan (NCCP) offers governments a strategic tool to improve the prevention of cancer and ensure that appropriate treatment and supportive care are available based on the country's specific needs and resources.
However, a September 2023 study by the Journal of Cancer Policy revealed that there is a scarcity of NCCPs in Africa, yet deliberate investment in cancer registry and clinical services is key to improving access to care and ultimately reduce cancer mortality on the continent.
Uganda, is one of the countries that has no cancer control plan and according to Dr Noleb Mugisha, the lead Comprehensive Community Cancer Programme at the UCI, the plan contains strategies that align all efforts and resources in curbing the cancer problem in the country.
“The fight against cancer in Uganda started in 1967 with the foundation of the UCI, but the efforts to contain it have been in vain because we do not have a control plan in place. We have drafted the plan that has been presented to the Ministry of Health waiting approval,” says Dr Mugisha.
He remarks that the plan is hinged on pillars of health promotion and cancer prevention that entails sensitising people about cancer in order to reduce the risk and prevent it.
Early diagnosis, as mentioned earlier is one of the challenges that will be addressed by the control plan. People do not have to travel very long distances to the UCI to get basic screening or even a surgery.
“We plan to begin cancer care at community level,” Dr Mugisha says. “At every health centre III, there should be awareness and screening services because these do not require high technology. The hospitals at district level should be able to carry out a biopsy and a surgery at a regional referral hospital.”
Palliative care, since cancer is a life-threatening disease is a very essential component in cancer care that is included in the NCCP. This is because palliative care, especially in patients with advanced cancer addresses the person as a whole, not just their disease.
The NCCP also focuses on strategies to integrate survivors back into their communities and restore their productivity. “Survivorship begins at diagnosis but in Uganda,” Dr Mugisha says, “We do not have a strong movement of survivorship. Those that exist are not very vibrant. We want to start cottage factories for survivors to manufacture artificial parts such as breasts, legs and any other parts the survivors may have lost due to the disease.”
He also remarks that they plan to help school going children on cancer treatment to continue studying since most of the childhood cancers are curable. “Many children lose hope of their education when they are diagnosed with cancer. With the plan, when these children complete the cancer treatment, they can always continue with their education,” says Dr Mugisha.
The policy and advocacy pillar emphasises sensitising people about adopting the right lifestyles, implementing the right policies and calling upon development partners to increase funding towards cancer care and prevention.
Dr Mugisha emphasises that the plan is drafted in a way that is building on the already existing programmes to avoid duplication of resources.
“While we fervently promote breast cancer awareness this October, the Uganda Cancer Society calls on the Government of Uganda to expedite faster adoption of the National cancer Control Plan,” Olodi urges.
Precept
The World Health Organisation (WHO) recommends that the national cancer control plan should be a practical guide for governments on how to plan overall cancer control effectively, according to available resources and integrating cancer control with programmes for other chronic diseases and related problems.
The modules are, prevention, early detection, diagnosis and treatment, palliative care, policy and advocacy.
