World Cancer Declaration: Assessing Uganda’s compliance to the set ambitious targets for 2020

 

By Moses Muwulya

 

In September 2008, a summit of more than 60 high-level policymakers, leaders and health experts adopted a global plan aimed at tackling the growing cancer crisis in developing countries.

The plan was contained in the World Cancer Declaration in which nine ambitious targets were set for countries to fulfill.

Listed from the first to the last, the targets included: Strengthening health systems for effective cancer control, measuring cancer burden and impact of cancer plans in all countries, reducing exposure to cancer risk factors, universal coverage of HPV and HBV vaccination, reducing stigma and dispelling myths about cancer.

Other targets were:  universal access to screening and early detection for cancer, improving access to services across the cancer care continuum, universal availability of pain control and distress management and the last one was improving education and training of healthcare professionals.

The declaration recommended fulfillment of the above targets by 2020; and further outlined priority steps that need to be taken in order to meet the set targets.

Strengthen health systems for effective cancer control. 

This target aimed at having health systems strengthened to ensure sustained delivery of effective and comprehensive patient-centered cancer control programmes across the life course.

To realize this target, Uganda has done a number of commitments, notably, the drafting of cancer control plan 2020 which will ease cancer resposnse.Drafted recently, the plan which is under review before it is submitted to the Ministry of health for review, according to Dr. Jackson Orem, the UCI Executive Director, focuses on the prevention and treatment of cancer and its related diseases in an all-inclusive manner unlike before.

Another manifestation of this target is Uganda Cancer Institute getting a semi-autonomous status and receive a separate vote gave the center of excellence mandate to coordinate prevention and treatment of cancer and conduct research on cancer in the country and further facilitated the setting up of cancer treatment centers in all regions, and source for funding to finance treatment of cancer patient. Apparently, it is sourcing funding for the building a cancer hostel to premise cancer patients who sleep on verandas as they wait for their rounds of treatment, which is a pitiable scene.

 

Measure cancer burden and impact of cancer plans in all countries

This required countries to establish population-based cancer registries and surveillance systems to measure the global cancer burden and the impact of national cancer control programmes.

Heeding to this target, a partnership with Fred Hutchinson Cancer Research Centre (FHCRC) saw a new cancer research, outpatient care and training facility at the Uganda Cancer Institute (UCI) developed with a focus on increasing research outputs

Reduce exposure to cancer risk factors

This tasked countries to have a significant fall in global tobacco consumption, overweight and obesity, unhealthy diet, alcohol intake, and levels of physical inactivity, as well as exposure to other known cancer risk factors.

Heeding to this, a number of actions have been taken. Notably is the passing of a comprehensive tobacco control law in 2015 to reduce tobacco use and exposure to second-hand smoke; although its implementation is yet to be fully realized. The president launched a national physical activity day to reduce on physical inactivity as well as curbing non-communicable disease risk factors.

However measures to reduce on alcohol intake are yet to be realized with the ban on sachet “waragi” hanging in balance

Reduction of other leading exposure to risk factors like asbestos, which, if exposed to, according to the  World Health Organisation-WHO,leads to different types of cancer, especially that of the lung, larynx, ovaries, and mesothelioma; and had since ordered to be removed from buildings, is yet  to be fully implemented. Many government institutions are still roofed with asbestos, like Uganda Police a question which authorities barely answer.

Universal coverage of HPV and HBV vaccination:

A target that sought to have cancer causing infections HPV and HBV covered by universal vaccination programmes,Uganda, has,  in compliance to it, issued two statutory instruments to advance the fight against Hepatitis B,whose virus is responsible for 80 percent  of liver cancers according to the  2018 world hepatitis day press statement on the progress of implementation of hepatitis b vaccination program in Uganda. The instruments are: The Public Health (Declaration of Hepatitis B as a Formidable Epidemic Disease) order, 2014 (SI No 104) and The Public Health (Vaccination of Health Workers against Hepatitis B virus)

Further to this, the Ministry of Health set elimination targets in 2015 to eliminate hepatitis B as Dr. Alfred Driwale, the assistant commissioner in charge of vaccines and immunization said in a telephone interview with this writer

“  The target was and still is that by year 2030 hepatitis B prevalence in children between 0-5 years should be at 0.1 percent, 0.1 percent means that when 1000 children in above age group are tested only one would be positive of Hepatitis B,” Driwale,who also doubles  as Uganda National Expanded Program on Immunization (UNEPI) Program Manager said.

He adds: “performance is good with 92 percent of the children started on vaccine completing their dosage, further warning the 8 percent that gets half of the dosage against the risk of getting exposed to Hepatitis B”

However, the so good a performance among children is not matching with adult vaccination efforts as the government seems to leave the battle to private health care providers yet  many cannot afford the costs. Stories of natives in the highly prevalent regions appealing to government to offer free vaccination have been reported by various media houses.

According to the 2016 Uganda Population-based HIV Impact Assessment (UPHIA)

Survey, prevalence of Hepatitis B infection among adults stands at 4.3% (5.6% among men and 3.1% among women). The survey indicates that Hepatitis B

Prevalence is highest in Northern region with 4.6% in mid North, 4.4% in North East and 3.8% in West Nile. Hepatitis B infection was lower in the rest of the country with a range of 0.8% in South West region to 2.7% in East Central region.

Regarding HPV vaccination to abet cervical cancer the leading cause of cancer morbidity and mortality among Ugandan women, the government in November 2015 lunched a nationwide HPV vaccination, targeting 850,000 girls aged 10-13. These were supposed to have two doses given in six months interval.

Asked about the progress of this campaigned Driwale explained that 67 percent of the targeted girls got their first dose and of these, 60 percent had since completed their second dose.

 Reduce stigma and dispel myths about cancer

This sought to have Stigma associated with cancer, and damaging myths and misconceptions about the disease dispelled.

As noted by Uganda Cancer Society in one of the it progress reports towards the declaration, the  inclusion of civil society and private sector actors in raising public awareness of cancer bids to realize this target.

Uganda Cancer Society is also working relentlessly with these organizations to intensify awareness raising efforts nationally to help dispel myths around cancer and provide life-saving information on screening and early detection.

However, there is still a strong mileage in scaling up awareness campaigns as the mystery about cancer still roofs the public both elite and not as Dr Ritah Nabulya,the medical services manager at Kitovu  Mobile,Kitovu Mobile, a venerable medical and community empowerment organisation, which offers palliative care to cancer, and other people living with life threatening chronic illnesses, cancer screening and awareness, among other medical services, notes

“Ignorance about cancer is still high with people still perceiving it as witchcraft, thus seeking none conventional interventions only to resort to conventional ones when the disease has progressed. The   first cancer we need to cure is the” cancer of ignorance” and then deal with other cancer types,” Nabulya says

She notes that awareness on cancer prevention channels like vaccination, signs and symptoms and the varied screening and treatment options need to be done.

Universal access to screening and early detection for cancer

This required having population-based screening and early detection programmes universally implemented and improved levels of public and professional awareness about important cancer warning signs and symptom.

The Uganda Cancer Institute has since established and  operationalised regional centers in Mbale, Arua and Gulu and Mbarara districts, a move which is not only  expected to decongest Uganda Cancer Institute,  but also easing access to screening and treatment since 85 percent of patients  received at UCI come from upcountry according to data  from UCI.

Improve access to services across the cancer care continuum

Access to accurate cancer diagnosis, quality multimodal treatment, rehabilitation, supportive and palliative care services, including the availability of affordable essential medicines and technologies, will have improved.

Bankers and state of the art radiotherapy machines have been installed to up the game of diagnosis.

Quality multi modal treatment is nearly realized as UCI uses radiotherapy, surgery, drugs, which play only 20 percent in cancer management, are a manifestation of availability of varied treatment modalities as Dr Jackson Orem, the Excutive Director, UCI, explained on a talk show about “the state of Cancer in Uganda” aired on NBS television,yesterday

Universal availability of pain control and distress management

Effective pain control and distress management services will be universally available. This target aimed at universal soothing of pain and distress management.

This can be realized through provision of holistic palliative care Mr Mark Donald Mwesiga, the country director of the Palliative Care Association of Uganda, palliative care is highly effective in managing pain and physical symptoms and can improve adherence to medications. “It can and should be delivered with curative treatment that begins at the time of diagnosis.”

He notes that by December 2019, there were in about 225 health facilities offering palliative care in 105 districts of Uganda. There were 30 districts without any form of palliative care being provided to those in need. Of these, 148 were public while 77 were private.

According to him, the most suitable model for the provision of palliative care, especially at the end of   life is home care. This is a type of care where health workers visit the home of the sick.

In Uganda, only private health facilities with a palliative care programme offer home care. Only 17 palliative care home programmes are available and they are all by private hospices and organizations. The government health facilities do not offer home care for palliative care patients.

It is upon this that Moses Mulumba, the CEHURD excutive director, stressed that Palliative care must be looked at as s a strong point, and the government cannot leave its provision cancer the private sector,

Mulumba,who made these great insights on NBS talk show about the state of cancer in Uganda, said the 80 percent of cancer patients who succumb to cancer should not die in a very disgraceful way and need to be universally catered for through palliative care “Dignity and being free from pain is important even when one is sick”

Improve education and training of healthcare professionals

Innovative education and training opportunities for healthcare professionals in all disciplines of cancer control will have improved significantly, particularly in low- and middle-income countries.

Dr Orem says UCI has trained best cadres of health care workers and continuously increases their capacity. He further notes that UCI  is working on a new Human resource infrastructure and acknowledges there more need to train  human resource  locally to offer services that are sought from outside. And all this need funding.