Dar es Salaam. Regular cancer screening and early diagnosis are rare in Tanzania. Consequently, by the time a cancer victim arrives at a healthcare facility, the cancer is often at an advanced stage, says Dr Julius Mwaiselage, executive director of the Ocean Road Cancer Institute (ORCI) in Dar es Salaam.
“About 90 percent of our cancer patients report at the hospital when it’s rather late. Someone in a rural setting may not know they have cancer until it’s too late,” says Dr Mwaiselage.
According to the latest report of the World Health Organization (WHO), the global cancer burden is estimated to have risen to 18.1 million new cases – and 9.6 million deaths – in 2018.
One-in-5 men, and one-in-6 women worldwide, develop cancer during their lifetime. In the event, one-in-8 men and one-in-11 women die from the disease.
Prevalence of cancer in Tanzania
Tanzania is no exception. Available data shows that cancer cases are on the rise in Tanzania, with reports from the ORCI showing that the number of people who receive treatment there rose from 35,367 during the 2014/15 financial year to 64,747 in FY- 2018/19.
Ocean Road data reveals that Dar es Salaam leads – with 16.88 percent of all the cancer cases diagnosed in Tanzania in 2016 – followed by Mbeya (10.83 percent), Morogoro (10.58 percent) and Kilimanjaro (8.31 percent).
In all these instances, there was an increase in the number of people tested for cancer over the years – which would account for the higher numbers, it has been revealed.
In spite of the emergence of cancer as a serious public health issue, Tanzania has only two cancer hospitals: ORCI as the main cancer hospital, and the Bugando Hospital in Mwanza Region.
Cancer treatment is free in Tanzania
Cancer patients in Tanzania have the constitutional right to be treated for free at the public hospitals, after being diagnosed with the malady.
However, they have to pay for screening and any necessary medication, mostly out-of-pocket.
In a country that has a vast land area with inadequate roads outside major urban centres, cancer patients face the additional challenge of having to travel to Dar es Salaam or Mwanza, which can be costly.
Moreover, the shortage of medical diagnostic devices and medicines force patients to turn to private pharmacies and other suppliers.
Those who can’t afford to pay out-of-their pocket simply wait for supplies at the public hospitals to be replenished, often suffering severe pain and losing crucial treatment time.
In spite of clear gaps and shortages, ORCI does better than many other cancer hospitals elsewhere in Africa.
Recent reports show that patients from neighbouring countries flock to Ocean Road for cancer treatment.
“We receive cancer patients from Kenya, Burundi, Malawi, Zimbabwe, Mozambique and the DRC,” says Dr Mwaiselage.
High-tech cancer machines installed at ORCI
In August this year, ORCI installed high-technology equipment, namely linear accelerators and CT simulator, which enabled the cancer hospital to start offering specialised cancer care services.
The public cancer hospital also recently received government funding amounting to Sh14.5 billion for purchasing more cancer devices, Dr Mwaiselage reveals.
“The machines which will be purchased include Cyclotron and PET/CT scanner,” says the Institute’s executive director.
Lack of accurate data/statistics on cancer patients
There are concerns that Ocean Road and other cancer treatment facilities do not have an established system to track and register cancer patients based on their exact place of origin. Therefore, keeping track of diagnostics is difficult – and follows-up for treatment a real challenge.
To address the challenge, the Health ministry’s deputy minister Faustine Ndugulile recently instructed the Ocean Road and other treatment facilities to closely collaborate with Tanzania’s largest public health research institution, the National Institute for Medical Research (NIMR) to conduct researches and come up with accurate data on cancer patients.
Public/Private Initiative introduced to enhance cancer care
Tanzania’s fight against cancer received a vital shot in the arm recently when the Aga Khan Health Services (AKHS) and the French Development Agency (AFD) signed an agreement and memorandum of understanding (MoU) for euros 13.3 million (about Sh38 billion) in grants.
The money – whose disbursement starts almost immediately – will specifically finance a four-year project known as the ‘Tanzania Comprehensive Cancer Project’ (TCCP).
Ten million euros out of the funds is in the form of aid from AFD, while the remaining 3.3 million euros is a grant from the Aga Khan Foundation Geneva which is part of the Aga Khan Development Network (AKDN).
The four-year TCCP, which starts in January 2020, will serve to accelerate performance in cancer screening, prevention and early detection, targeting low-income segments in Society through mobile outreach campaigns.
The colourful signing event was attended by various representatives from the government, the private sector and the country’s development partners.
Speaking during the signing, a consultant oncologist at the Aga Khan Hospital in Dar es Salaam and the TCCP director, Dr Harrison Chuwa, said the project was designed to reduce the burden of cancer mortality and morbidity in the two target administrative regions of Dar es Salaam and Mwanza.
This will be achieved through a strategy that focuses on enhanced healthcare performance.
It will also expand the outreach of the Tanzania-based implementing partners, including the Aga Khan Health Services in Tanzania (AKHST), ORCI, the Muhimbili National Hospital (MNH)m the Health Ministry and the Bugando Medical Centre (BMC), as well as the Dar es Salaam and Mwanza regional secretariats, Dr Chuwa explained.
He also asserted that, under the project, the implementing partners will create an integrated health care network at the local and hospital levels to accelerate performance in cancer care in the country.
The objectives of the project
Stating the objectives of the project, the AFD Country Director, Ms Stephanie Mouen, oozed optimism that the proposed project will complement the government’s efforts at creating increased access to cancer care for the vulnerable populations in Tanzania.
In tandem with the project’s objectives, the project will contribute to the establishment of an Oncology Centre at the Aga Khan Hospital in Dar es Salaam and the purchase of two linear accelerators and a remote after loader brachytherapy machine.
There will also be the establishment of a modern laboratory at MNH which will be the first molecular and digital pathology laboratory in the country.
Furthermore, new ultrasound and 3D mammography machines will be installed at the ORCI and Bugando Medical Centre in a bid to improve early cancer diagnosis.
In his speech, the Chief Guest at the ceremony, Dr Ndugulile, thanked the project funders – AFD and AKDN – for the major step they have taken in fulfilling the need and extending funding for enabling the provision of cancer treatment in Tanzania.
“Among the diseases which the government has earmarked as a special priority is cancer, which is one of the major ailments that affect millions globally and locally,” said Dr Ndugulile.
Plans to extend cancer care are under way
The government recently revealed that at least 100 healthcare centres will be enabled to provide basic oncology services, and 300 health workers from the tertiary to the dispensary level will be trained in efforts to enhance cancer care in Tanzania.
Renewing commitment to fight non-communicable diseases
In a bid to prevent and control the rising threat of non-communicable diseases (NCDs) like cancer, Tanzania-Mainland recently launched a new National NCD Programme.
So far, coordinated response to reduce the burden of NCDs has been guided through two strategic plans, 2009-2015 and subsequently the current National Multi-sectoral Strategy and Action Plan for the Prevention and Control of the NCDs 2016-2020.
Tanzania and other low-income countries face a heavy burden of communicable diseases including HIV/Aids, malaria, tuberculosis and cholera.
In Tanzania, statistics from routine health surveys show a 24 per cent increase in the number of patients treated for NCDs from 3.4 million in 2016 to 4.2 million in 2018.