African approach to cancer vital

African countries face many challenges when providing health services in general, and care of cancer patients in particular. Financial constraints are one obvious barrier. But many others exist, and need to be understood by anyone seeking to improve the situation.
For example, all African countries suffer from insufficient scientific and epidemiological information (required to guide resource planning), as well as a shortage of professionals trained to provide the necessary clinical care. In addition, many face competing health and other social priorities, as well as political insecurity and even wars, which can each divert attention from long-term health care issues. Finally, social and cultural factors frequently obstruct the timely and effective delivery of care.
All these hurdles apply across the board to health care. In addition, however, others are specific to cancer. In particular, misconceptions about cancer can impede efforts aimed at early detection and make patients reluctant or unwilling to seek care when they notice early symptoms. Overburdened and underfunded health care systems are at the root of many of the health problems in Africa. Inefficient health management, together with disorganised governmental structures, further contribute to the financial burdens facing health care.
As a result, financial allocations for health care are mostly driven by crisis management rather than long- or even mid-term strategic planning. On top of all this, African countries face the fact that resources are often allocated based on bureaucratic procedures or political goals, rather than coherent public health policy.
This makes it virtually impossible for patients – particularly cancer patients – to receive appropriate care in a timely fashion, as major components of heathcare infrastructure, as well as the resources needed to implement improved care, are lacking.
An additional problem is that the developed world has demonstrated that most cancers are curable if detected and treated in the early stages. But this does not apply in Africa, where about 80 percent of all cancer patients have advanced-staged disease when they first see a doctor. Furthermore, in many African countries, cancer is not an explicit priority for spending on health care, and cancer awareness is very low. To tackle cancer, African politicians must recognise that the disease is a major public health issue.
One reason that the challenge of cancer in Africa is underappreciated is the lack of population-based incidence and mortality data. Too much reliance is placed on data from the West. These data are often not useful when trying to generate compelling evidence-based guidance on how cancer in African countries can best be addressed. Recruiting, training and retaining health care professionals are another problem. Qualified physicians, nurses, and allied health care personnel are scarce in Africa, partly because there are insufficient funds to fully equip hospitals and provide either competitive salaries or opportunities for career development.
The situation is worsened when health care professionals migrate from rural to urban areas, move from public to private health sectors, and emigrate from Africa to richer countries. Africa has to come up with solutions to address this brain drain if it is to improve cancer services in the continent. Even those who do take on appointments can become frustrated and disenchanted when the infrastructure they need to carry out their work is lacking. For example, more than 20 African countries do not have any radiotherapy treatment facilities, despite their important role in cancer treatment. Three types of research – basic, epidemiologic and interventional – are relevant to caring for cancer patients, and each can, at least in principle, be carried out in Africa. Yet research is still considered a luxury in many African countries. – SciDev.Net.

l Twalib Ngoma is executive director of the Ocean Road Cancer Institute, in Dar es Salaam, Tanzania.