Robin Muchetu, Health and Gender Editor
BREAST cancer is the second most common cancer among women in Zimbabwe and a number of patients face socio-economic barriers to accessing oncology care, including radiotherapy.
Cancer services are available in Zimbabwe and are offered at all levels of the healthcare system with care concentrated at tertiary and quaternary levels.
According to the National Cancer Control Plan (NCCP) cancer service delivery focuses on the following areas: cancer prevention, early detection, diagnosis, treatment, palliative care, rehabilitation and survivorship.
Integrating cancer prevention, screening and early detection into other programmes is crucial for optimal public health benefits and long-term cancer control.
Potential integration areas include sexual and reproductive health initiatives, existing HIV/Aids programs, national immunisation efforts for HPV and Hepatitis B and C, occupational and environmental health initiatives, maternal and child health programs and lifestyle modification.
What plans are available?
For breast cancer treatment and care clinical oncology, services such as oncological surgery, radiation oncology, medical oncology and haematology are primarily available at central hospitals, including Parirenyatwa Group of Hospitals, Sally Mugabe Central Hospital, Mpilo Central Hospital, United Bulawayo Hospitals and Chitungwiza Central hospitals. The NCCP prioritises upgrading existing services and decentralizing cancer treatment.
Surgical oncology
\There are various surgical specialties available in Zimbabwe at central and provincial hospital level. Surgical specialties include general surgery, neurosurgery, cardiothoracic surgery, urological surgery, ophthalmology, otolaryngology, gynaecological and paediatric surgery.
Cancer patients mostly get surgical services in the public health sector and advocacy for strengthening of surgical capacities at the secondary, tertiary and quaternary level is a priority.
Medical oncology
This involves treating cancer with chemotherapy, hormonal therapy, biological therapy and targeted therapies. Currently, radiation oncologists practice this field in Zimbabwe. Public patients access chemotherapy services at Parirenyatwa and Mpilo Hospital Radiotherapy Centres.
Cancer palliative care, rehabilitation and survivorship
A Palliative Care Policy and Strategy are both in place. The policy addresses pain management and the psycho-social and cultural needs of all people living with cancer including children. There is a need to improve access to palliative care country-wide through essential medicine provision, training of service providers, research and integrated teamwork.
Since 2017, Zimbabwe embarked on an initiative to integrate palliative care into the public health system, across all pillars and anchored on having health care workers and institutions capacitated and mentored on palliative care.
The Zimbabwe National Cancer Registry (ZNCR) was established in 1985 and it performs active and passive case-finding based on public and private hospital in-patient and out-patient records, public and private histology reports, radiotherapy records and death certificates.
The Registry receives notifications from provincial, district, rural and mission hospitals. The ZNCR is central in monitoring and evaluating the National Cancer Control Plan.
Several gaps however exist in access, availability, affordability and quality of cancer treatment services that need to be addressed. Prevention offers the most cost-effective strategy for control of cancer.
Integration of screening and early detection in other existing health programs will give optimal public health benefits with minimal cost implication and long-term cancer control benefits.
The control plan however highlights that there are on-going Government efforts to train healthcare workers in cancer services subspecialties, but the numbers trained fall short of meeting the country’s requirements.
“There is a need to address gaps in numerical adequacy of service providers, conditions of service, knowledge gaps in cancer management and safety concerns for the health workforce. Financing for cancer remains a challenge for Zimbabwe with preceding efforts being underfunded due to competing priorities,” reads the plan.
Deliberate efforts will be made to ensure adequate and sustainable funding for cancer prevention and control.
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