Strategies for Tackling Non-Communicable Diseases in Africa: The Case of Cancer Care and Control
The Cancer Care and Control South-South Knowledge Exchange brought together stakeholders from five countries in Africa — Botswana, Kenya, Rwanda, Uganda and Zambia — to share experiences, lessons, and good practices. All five countries have initiated various programs to tackle the growing burden of cancer and have much to learn from each other. The knowledge exchange aimed to raise awareness, increase knowledge of effective strategies, and bolster regional collaboration.
Currently, 80 percent of disability adjusted years of life lost to cancer is in the developing world, but only 5 percent of global cancer resources are spent in these countries. With increasing urbanization, aging populations and changing lifestyles, the burden of cancer in Africa is projected to double by 2020. The situation in Africa is dire as health systems are dealing with a double burden of disease—a large unfinished communicable disease agenda and a growing non-communicable disease burden. Awareness levels about cancer are low, with most patients arriving at health facilities at an advanced stage of the disease, which leads to a poor prognosis and low survival. In most countries there are: few facilities that provide care, almost exclusively in urban areas; serious shortages of qualified medical personnel; and large financial barriers, as the cost of care is beyond the means of the majority of the population.
In spite of the numerous capacity, institutional, and financial constraints some countries have initiated programs and made important progress in various aspects of cancer care and control (CCC). Botswana, Kenya, Rwanda, Uganda, and Zambia were selected to participate in this knowledge exchange, as they have demonstrated high level commitment, made important strides in key areas, and were keen to learn from one another. The knowledge exchange therefore brought together policymakers and mid-level managers from these countries to share successful experiences and discuss effective cancer care and control strategies; learn of available resources; and network with international experts to build capacity for cancer care and control. The peer-to-peer learning was expected to serve as a platform for discussing common constraints and challenges and identifying practical ways to address them.
Over the course of 18 months, from August 2013 to February 2015, participants attended a series of videoconferences, shared their experiences, and discussed common problems. Organizers worked with participants to ensure the program addressed their interests and connected them with technical experts who are conducting cutting edge research. The virtual meetings were followed by a face-to-face regional workshop in Lusaka, Zambia at which participants learned firsthand of the achievements of Zambia’s Cancer Diseases Hospitaland theAfrican Center of Excellence for Women’s Cancer Control at the Center for Infectious Disease of Zambia,and explored opportunities for collaboration.
The various interactions led to the following:
- Shared knowledge and experiences on the main building blocks of cancer care and control programs with a full range of topics covered, including:
- Innovative approaches for strengthening cancer prevention efforts.
- Strategies for implementing successful national CCC programs.
- Task shifting and other capacity building strategies to increase access to care.
- Tools for analyzing CCC costs.
- Financing models, including public private partnerships, to increase access to CCC treatment and care.
- Data collection to better document the burden of disease.
- Policy reforms needed to increase access to palliative care.
Established a platform for cross country collaboration. The organizers facilitated communications across countries, to enable continual sharing of tools, experiences and latest research findings. Identified opportunities for collaboration (e.g. join training, technical support, research) with one another and with institutions in the region such as the Center of Excellence for Women’s Cancers in Zambia, the Butaro Center of Excellence on Comprehensive Cancer Care in Rwanda and the East Africa Oncology Institute in Uganda.
- Peer-to-peer learning through a client-oriented, participatory process offers a collegial and collaborative environment for sharing insights, experiences, and lessons. This type of learning is highly valuable, relevant, and timely as reflected in feedback from participants.
- Face-to-face interactions between practitioners and policymakers from the participating countries strengthened understanding of how innovative programs were spearheaded, resources were mobilized, and political commitment was bolstered.
- A demand-driven approach was critical to soliciting views of participants about the most relevant topics to be covered and ensuring the knowledge exchange responded to client needs.
- Strong collaboration with other technical partners was requested by participants and proved highly effective. Technical partners brought a global perspective and offered complementary information which was appreciated by all stakeholders.
- Strong preparation is essential to success. The knowledge exchange activities need to be well organized, materials need to be concise, and communication channels need to run smoothly, to maximize learning for busy practitioners and policymakers. Soliciting regular feedback from participants is critical to ascertaining views and ensuring that the knowledge exchange is tailored to country demands.
The World Bank served as convener and organizer of the knowledge exchange. The Bank mobilized the United States National Cancer Institute (NCI)/National Institute of Health (NIH) to participate in the initiative, leveraging technical expertise in highly specialized areas (e.g. cancer epidemiology, planning, treatment, pathology). With a trust fund of $49,000, the Bank’s team produced a technical paper and other materials that were appreciated by participants, and recorded several video conferences to facilitate learning.
The main partner in the knowledge exchange was the U.S. National Cancer Institute/NIH. The organization was represented by world class experts at all events, and shared the latest information and most recent policy developments from the global community. Other partners included the African Palliative Care Association, AMPATH (Kenya), and the Nairobi University pathology department, which shared information about their programs and activities.
The knowledge exchange established a platform for collaboration and information sharing which continues beyond the formal closing date. Participants are in the process of incorporating lessons learned into their national programs; continuing to exchange information and materials with peers in other countries; and deepening their collaboration with technical partners on several aspects covered during the period (cancer planning, cancer registries). One example worth noting is the East Africa Public Health Laboratory Networking Project, which will be used as a vehicle for strengthening the availability of pathology services at project-supported laboratories in Kenya and Uganda.
- Participants found the knowledge gained relevant and useful. “I will share the knowledge with the hope that it will influence policy in my own country”, noted one participant.
- The knowledge exchange motivated participants to advocate for better cancer care and control: “I will lobby for government support in setting up a cancer treatment center in Kenya. We are hosting the First Ladies Conference this year and shall use the platform to lobby government for more resources.”
- The knowledge exchange also enhanced appreciation of the potential of partnerships. “Regional partnerships are key . . . countries need to put efforts into supporting each other to ease the patients’ burden.”
- Experts meet in Lusaka to share knowledge on Cancer Control and Care: http://www.ehospice.com/kenya/ArticleView/tabid/10674/ArticleId/14178/language/en-GB/View.aspx#.VO-olQ5xlNo.mailto
- African Center of Excellence for Women’s Cancer Control at the Center for Infectious Disease of Zambia: http://www.acewcc.org/
- Revolutionary Cancer Care in Rwanda: http://www.pih.org/blog/revolutionary-cancer-care-in-rwanda
- Uganda Cancer Institute Becomes Centre of Excellence: http://www.uci.or.ug/news/81-uci-becomes-east-africa-s-center-of-excellence
Zambia Cancer: https://www.youtube.com/watch?v=T0ICZ4d7RSQ