Subsidising cancer treatment, Zim’s biggest challenge

 

By Caiphas Chimhete

GOVERNMENT must urgently invest extensively in cancer research focusing on prevention, treatment and care of patients in order to address the growing cancer crisis, which is claiming thousands of lives annually, a leading health advocacy group has said.

Also proposed, is the subsidisation of cancer treatment either partly or fully, making it free or affordable to ensure that every citizen can access care without financial difficulty to enable the attainment of health equity. The current high cost of cancer treatment remains a stumbling block to many as they vary between US$150 and US$1 000 per session, essentially excluding most of the poverty-stricken Zimbabweans from getting treatment. This calls for a subsidy for cancer treatment to ensure health equity.

Community Working Group on Health executive director, Itai Rusike, says government should declare cancer a public health emergency so that increased funding can be channelled towards stemming the scourge that has caused unnecessary human suffering and avoidable deaths. He called for increased targeted funding from the national fiscus accompanied by a massive community awareness drive to increase knowledge and douse the fears, myths and general misconceptions associated with the disease.

“Cancer is now a humanitarian disaster that needs urgent State intervention,” Rusike said. “We need to put more resources into research, treatment and care of patients and we should also make sure we raise awareness in different communities if we are to end this scourge.”

His clarion call comes as the world commemorates the breast cancer month of October, a time to remind governments and other health service providers to seriously consider other ways they can assist patients and families in the prevention, early detection and treatment of the deadly non-communicable disease.

Breast cancer is the second most common cancer among women after cervical cancer. Cancer of the breast, although it is mostly associated with women, also affects men.

According to the Zimbabwe National Cancer Registry (ZNCR), the country recorded 7 841 cancer cases in 2018. Of the total cases, breast cancer accounted for 8%, cervical cancer 21%, prostate 11% and the rest included many other types of cancers. Of the 2 743 cancer deaths recorded that year, breast cancer accounted for 7%, cervical 13% while prostate cancer accounted 10%.

However, it is widely believed that these known statistics are just a tip of the iceberg as many cancer patients are not recorded as they do not present for treatment at conventional health facilities and several of the deaths are not registered.

Of those who do report, the majority are already at an advanced stage of the disease, due to limited access to screening services pointing to an urgent need to raise awareness in communities. The lack of adequate knowledge leads to delayed presentation of cases at health institutions. In 2018, ZNCR reported that over 80% of the cases were diagnosed at advanced stages. Increase in cancer awareness can empower people to recognise early warning signs, make informed choices about their health and counter their own fears and misconceptions about the disease.

Rusike proposed the integration of cancer control in community, school and workplace health promotion programmes as a multi-faceted approach was the sure way of curbing the menacing disease. He said it was of critical importance that communities are educated on the importance of early screening and treatment to avoid the progression of the disease, the resultant pain as well as the overwhelming costs that patients must endure.

Access to cancer information and management services is limited and greatly varies according to one’s economic status, with poor members of society barely getting the minimum in accurate information at the right time. This emphasises the importance of calls for collaboration between the Health and Child Care ministry and alternative healthcare service providers to tap into existing knowledge systems and practices that can be adapted to assist in combating cancer.

It is essential to rope in the media to be part of the broader campaign, as the media are ideal for the dissemination of accurate updated information to the public. Issues to do with cancer just like HIV/AIDS could also be included in the journalism curriculum to ensure correct and informed reportage that is rights-based, experts say.

The Cancer Association of Zimbabwe (CAZ) is running this month’s national awareness campaign under the theme, “Find It, Fight It, Win the Battle”.

“Join us in spreading awareness, promoting early detection and supporting survivors. Together we rise above breast cancer,” said CAZ, as it rallies all stakeholders in efforts to eradicate breast cancer.

There is a great necessity to decentralise the cancer prevention and control programme utilising structures like those of the National AIDS Council to ensure everyone has access to cancer services. Presently, there are only two public cancer treatment centres that offer chemotherapy and radiation treatment at subsidised prices in Bulawayo and Harare but are over-subscribed.

The only cancer services on offer in most of the country’s rural health centres are screening using visual inspection with acetic acid and cervicography and referrals for further tests, treatment and therapy at district and provincial level. Again, this makes treatment — coupled with transport costs — beyond the reach of many.

“I, therefore, urge the government to avail free screening including Pap smears (a procedure to test cervical cancer in women), clinical breast examinations and prostate-specific antigen tests at primary health level,” Rusike said.

He noted that cancer should be made a standalone health issue, with an established multi-sectoral national taskforce specifically tasked with addressing all the challenges associated with the disease. Additionally, cancer must also be added to the list of notifiable disease in the long run making it legally mandatory for health providers to report cases to state or local public health officials.

“With appropriate investment, planning and advocacy, we can ensure that patients accessing health care services in the country would be assured of their right to receive quality treatment and care regardless of whom and where they are,” Rusike said.

Fighting the cancer menace requires strengthening health systems including improvement of human resources for health and reducing the current brain drain. It also calls for the review of the current staff establishment to reflect the current disease burden and population growth to ensure better health outcomes.

Health equity requires a strong political will to invest in health infrastructure, equipment, human resources, and medical products.

Rusike applauded the government’s current efforts in coming up with the national cancer control plan 2022–2026, a guiding document for cancer prevention and control. However, he urged the government to fully resource the strategy development process to ensure a comprehensive funded roadmap that will effectively address the current cancer menace.

 

 

 

Cholera strikes in Harare

A CHOLERA outbreak has hit Harare with five confirmed cases reported so far, health authorities have revealed.

The waterborne disease, which spreads through drinking water or eating food contaminated with the cholera bacterium which causes severe diarrhoea and vomiting, is now endemic in the country.

In a notice, the Harare City Council said three of the cases were linked to Buhera where there was a cholera outbreak last week, while two other cases were contracted from local sources.

“The city would like to inform residents that it has now five confirmed cholera cases in Hopely Zone 5, Stoneridge, Southlands, Granary and Adbernie Mbare. We urge all residents in these affected areas and greater Harare to take necessary precautions to avoid contracting cholera,” council said.

Deputy mayor Kudzai Kadzombe told NewsDay that the council was taking steps to contain the outbreak.

“As a council we are working on increasing water production and our Beatrice Infectious Hospital is actually ready for any case that can arise. We have our employees on standby waiting for any case,” Kadzombe said.

Community Working Group on Health executive director Itai Rusike said recurrent cholera outbreaks were concerning

“Zimbabwe needs to strengthen the primary health care principles and the laws regarding public health which explicitly state that communities have a big role to play in public health, but they need an enabling environment for them to do so effectively,” Rusike said.

Zimbabwe Nurses Association president Enock Dongo urged locals to exercise caution in order to stop the disease from spreading.

“This is a very preventable disease and it can be fatal if not treated. People should practise hygiene. It’s all about washing hands and drinking clean water,” Dongo said.

Meanwhile, the Health and Child Care ministry has banned church camp meetings, open markets, communal beer gatherings among other measures to curb the spread of cholera in Zaka, Masvingo.

The 2008 cholera outbreak, which started in Harare and later spread into neighbouring countries, was the deadliest — killing more than 4 000 people and affecting over 100 000 others.

Prioritise primary health care, govt urged

Mr Itai Rusike

A LOCAL health lobby group, Community Working Group on Health (CWGH), has called on the incoming government to prioritise primary healthcare to achieve universal health coverage.

CWGH executive director, Itai Rusike, said Zimbabweans expected government to address the health sector’s multifaceted challenges.

“All political parties promised massive improvement in health infrastructure; more health personnel; accessible and affordable medicines; free medical care, improved health services in resettlement areas and pursuing the health for all policy, among others,” said Rusike.

“As CWGH, we summarize this as primary healthcare with clear intentions for the attainment of universal health coverage and, therefore, Sustainable Development Goals.”

He said the incoming government should “immediately shift focus to real developmental issues, particularly taking into account the dire need for improving health service provision for the benefit of ordinary Zimbabweans as articulated in the pre-elections (campaigns)”.

Rusike said the deplorable state of the country’s health system required urgent attention, starting with the primary healthcare system.

Zimbabwe needs sustained investments in primary healthcare to revitalize the health system to close gaps in access to services and to address the causes of ill-health, he said.

“Presently, infrastructure in hospitals is dilapidated, some is obsolete; medicines and supplies are in short supply; doctors, laboratorians, pharmacists, paramedics and nurses are inadequate and poorly motivated. This is against a background of sustained paltry funding to the sector from the fiscus which is of major concern.”

Rusike said the problems in the health sector were compounded by the prevalence of largely preventable diseases, behavior, lifestyles, environmental and basic water and sanitation issues.

“In recent years, many countries have adopted universal healthcare as a national priority and have committed to directing government funding towards that goal,” he said.

Engage communities in budget, CSOs urge African govts

CIVIL society organisations (CSOs) across Africa have said community participation is key in budget advocacy processes as a reminder to governments on the continent as they make budgetary plans for the coming year.

During the just-ended African Regional Advocacy Summit for NGOs and Media in Nigeria, CSOs said the community remained an important stakeholder in influencing budgetary outcomes.

Zimbabwean team leader Nonjabulo Mahlangu said communities provided valuable local knowledge and first-hand experiences that can contribute to the budget process.

“Communities can give a human face to the issues that they face, and share their experiences as far as access to health is concerned. They can share stories on the availability, affordability, appropriability and accessibility of the services,” Mahlangu said.

“This will assist in identifying gaps that need to be closed. There are various platforms where communities can participate, both at community and national levels. CSOs can raise awareness on existing spaces where communities can participate or create platforms for participation, bringing leaders to the communities.”

Project officer for the Africa Health Budget Network Health Security project, Health Alert Sierra Leone, David Joseph Allieu said community engagement in the budget process started from the community itself.

“We have the responsibility to add our voice to the budget process. It helps identify and prioritise needs as aligned to specific areas. Communities can provide feedback on services, programmes and infrastructure projects that can inform the allocation of resources in a way that reflects real needs,” Allieu said.

CSO stakeholders and media from eight countries which met at the summit also discussed the way forward in improving budgetary allocations to the health sector.

 

Prioritise health security, African nations urged

THE Africa Health Budget Network (AHBN) has urged African countries to take the issue of health security seriously as the continent struggle to recover from the COVID-19 aftershocks.

African countries’ health delivery systems are currently on their knees, including in Zimbabwe where shortages of medicines and life-saving equipment are prevalent.

Officially opening the first African Regional Advocacy Summit for NGOs and Media in Nigeria on Tuesday, AHBN co-chairperson, Muhammad Usman said COVID-19 was a reminder of the need to invest in the health sector.

“We need to take the issue of health security in Africa seriously,” Usman said.

“Let us use opportunities and experiences from past events that have affected the health sector so that a positive attitude is embedded within us. We need to focus around what we need to do to ensure that we engender accountability in our health sectors. We need to take the COVID-19 experience to advance health security in Africa.”

Community Working Group on Health executive director, Itai Rusike said raising domestic public funds was essential for universal health coverage.

“Health is recognised as a fundamental right in the Zimbabwe Constitution,” Rusike said.

“This, therefore, implies that everyone should have access to the health services they need, when and where they need them, without suffering financial hardship. Currently only about 7% of Zimbabweans have access to medical insurance and this number is insufficient to ensure decent public healthcare. No country can prosper without a healthy citizenry.

“The current health financing model also remains unsustainable as it heavily relies on external financing as well as out-of-pocket financing. In spite of the huge external support from development partners, there is still a huge financing gap in the health sector in the country which calls for greater innovation and commitment by the government to sustainably address it.”

Non-governmental organisations and the media from eight targeted countries of Sierra Leone, Nigeria, Senegal, Uganda, Zimbabwe, Malawi, Kenya and Cameroon, with funding from Ford Foundation and COPASAH are attending the four-day summit.

‘Men die earlier than women in Zimbabwe’

THE Bible speaks of humans who lived the longest in the history of mankind, the oldest having died at the age of 969 years – Methuselah.

Those who lived the longest are all men. Although less is said about matriarchs, it’s quite clear that men lived longer back then.
Sadly, centuries later an average Zimbabwean male is expected to live for about 61, 2 years with statistics showing that men account for more deaths in the country compared to women. Women live significantly longer than men as they have a higher life expectancy of 68 years.

Life expectancy refers to the number of years a person can expect to live and it is based on an estimate of the average age that members of a particular population group will be when they die.