Cancer in Africa needs a local approach
Cancer care in Africa faces the same challenges as general healthcare, but also needs local data and targeted solutions, says Twalib Ngoma.
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 healthcare issues. Finally, social and cultural factors frequently obstruct the timely and effective delivery of care.
All these hurdles apply across the board to healthcare. 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 healthcare 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 healthcare.
As a result, financial allocations for healthcare 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 per cent 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 healthcare, 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 healthcare professionals are another problem. Qualified physicians, nurses, and allied healthcare 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 exacerbated when healthcare 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.
For epidemiological research, Africa needs cancer data registries, whether these are broad regional and national cancer registries, or more limited study-specific registries intended to measure the outcomes and effects of specific interventions.
Africa also requires better 'needs assessments' in both the general and the medical communities, asking the public and healthcare professionals respectively what their needs are, and what problems they face.
Assessing needs is essential for tailoring treatment to specific healthcare settings. Importantly, most cancers seen in Africa have different causes, epidemiology and biological behaviour compared with those seen in the western world. So Africa cannot just extrapolate knowledge and experience from the West.
Instead, Africa needs local, effective and sustainable research. If this research is not relevant to rich countries, it may be unrealistic to expect them to finance it.
Researchers must also remember that, since African countries have different levels of resources, populations, prevalence of disease and other factors, each country will require different solutions for the same cancer problems.
The good news is that the commonest cancers in Africa are caused by viruses, against which new interventions — namely vaccines — are being developed. But the high costs of these vaccines mean that most African countries cannot afford to buy them.
Africa needs concerted efforts by the donor and international community to make these vaccines accessible to those Africans who need them most.
If the obstacles outlined above were to be properly addressed, Africa could improve its cancer services, even without much additional funding from the rest of the world.
Twalib Ngoma is Executive Director of the Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
This article is part of a Spotlight on Tackling chronic diseases.