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Why Africa needs to collaborate more than ever in cancer control efforts

The proportion of the overall disease burden in sub-Saharan Africa attributable to cancer is rising. The region is predicted to have a greater than 85 percent increase in cancer burden by 2030.

A strategic approach to cancer control in sub-Saharan Africa is needed to build on what works there and what is unique to the region. It should ideally be situated within strong, robust, and sustainable health-care systems that offer quality health care to all people, irrespective of their social or economic standing.

In 2018, there were over 752,000, new cases of cancer, and an estimated 506,000 deaths, which is 4 percent of the global cancer total to our population. Nigeria is a major contributor to the cancer burden in Africa with over 100,000 cases and more than 70,000 deaths.

However, to achieve this will need new leadership, critical thinking, investment, and understanding.

“The world has made significant progress in disease prevention and treatment; however, the benefits of this progress are not equitably distributed. The same is true for cancer diagnosis, prevention, treatment, palliative care, and control,” said Osagie Ehanire, minister of Health at the webinar of the African cancer CEO’s forum with the theme, ‘The State of Cancer Control Amidst Covid-19’ held last Thursday.

Ehanire said oncologists are now using scientific innovations like immunotherapy to target cancer, stop or slow the growth of cancerous cells.

“We have also seen other innovations like gene therapy, radiomics, thermal ablation of tumours and many others across the world. Countries like the United States have averted millions of deaths as a result of advances in cancer treatment and care.

“Over 50 percent of cancer diagnoses in many African countries are related to infections and largely preventable. Cancer incidence and mortality are increasing in Africa, as more people are dying undiagnosed, there is limited access to data to know the accurate magnitude of cancer burden in our continent, national cancer screening is still at a rudimentary stage, while many parts of the world are targeting at eliminating preventable cancer like cervical cancer by 2030/35,” he said.

According to the minister of Health, 80 percent of Africa- a continent of 1.3 billion people is yet to have access to human papillomavirus (HPV) vaccine. Cervical cancer is one of the starkest examples of global inequity in health and health injustice meted on women and girls living in the world’s most vulnerable communities.

“Clearly, Africa needs to collaborate more than ever in her cancer control efforts. In Nigeria, the Federal Government has committed to the introduction of Human Papilloma Virus (HPV) vaccine into the routine immunization schedule by the first quarter of 2021.

“We will budget for it and match our words with action. Nigeria is strongly committed to achieving the WHO’s global target of 90percent coverage of HPV vaccination of girls, 70percent coverage of cervical screening and 90percent treatment of cervical by 2030.

“We have achieved this success before in HIV/AIDS, we can do it again. I want to reassure you, our global partners and Nigerians that Nigeria government is ready to transparently work with you all in the elimination of cervical cancer.

“The challenge with cancer control in Nigeria is not only early detection, but also early treatment. Some indigent cancer patients present with a cancer diagnosis but are not able to access cancer treatment early because of cost,” said Ehanire.

Ehanire pointed out that in the 2020 budget signed by President Muhammadu Buhari, N729, 861,797 was appropriated for the Catastrophic Health Fund (CHF), a fund to support the treatment of indigent Nigerians diagnosed with breast, cervical and prostate cancer.

“The Federal Ministry of Health will ensure that this fund is released in this budget cycle. Urgent release of this fund is absolutely significant to increasing access to cancer treatment in Nigeria,” he said.

The minister added that in 2018, “We launched Nigeria’s National Cancer Control Plan with a budget of $308million to control cancer in all ramifications and $192million for prevention for 5years. The Federal Government is now encouraging all states in Nigeria to take up this cancer plan and make an investment to save lives in their various states. If the state governments can make an investment in cancer control, we will make progress in early detection and reduce late detection in Nigeria.”

The Federal Government has seen the benefits of public-private partnership (PPP) in the Nigeria Sovereign Investment Authority (NSIA) – Lagos University Teaching (LUTH) Advanced Cancer Treatment Centre. We are also calling on more public-private investment in cancer control.

“Cancer is not selective, cancer affects all. Painfully, cancer is taking away our fathers, mothers, sisters and children every single day. In the spirit of togetherness, we can reduce the burden and increase survivorship.

“Yes, Covid-19 has impacted our health systems, but we must pick ourselves up, re-strategise to build health systems that are resilient and proactive to the needs of the African population. The time for African government, civil societies and other stakeholders to commit to cancer control is now, we can do this if we have a shared goal and join forces today,” he said.

Also in the same vein, Zainab Shinkafi-Bagudu speaking on the topic ‘The Building Blocks to Achieving Cervical Cancer Elimination in Africa by 2030’, said that the words Cancer and COVID-19 have now become part of the Nigerian lexicon, both have made intrusions into our realities and their effect cannot be ignored.

“Anecdotal evidence and epidemiological data are a testament to increasing prevalence of Cancer in the continent and we are witnessing increased morbidity and mortality as a result of this complex disease.

“We are presently living through a global pandemic that for a period halted life as we have known it, and we are not out of the woods yet. The COVID-19 pandemic has unfairly impacted cancer patients, gravely exposing grave cancer care gaps in the income countries and understandably more so in LMIC, where even prior to the pandemic, patients travelled significant distances to access services, amidst other issues of a weak health system with inadequate funding,” she said.

According to Shinkafi-Bagudu, these realities demand that we institute resilient public health systems; prioritizing primary healthcare delivery, programs that deliver disease prevention, and ensuring equitable access to specialist medical services.

“Governments across the continent must drive policy and practice to control NCDs; cancer control plans must jump out of printed pages and translate into well-funded programs in Africa.

“Cancer control must be decentralised to rapidly turnaround the current cancer care narrative in Nigeria. State governments must localise and own the national cancer control plan, whilst prioritising awareness and prevention interventions. Cancer non-profits across the country are eager to partner with state and local governments to drive awareness and facilitate the capacity building of healthcare workers in our PHCs; healthcare workers at our PHCs are critical to prevention and early detection interventions,” she said.

Shinkafi-Bagudu added that we can continue advocating for innovative and resource sensitive approaches to deliver cancer control and eventual elimination in Africa. This will require that we speak with one voice from our different countries and regions, aligning our objectives and proffering sustainable solutions.

“We cannot afford to miss this moment in our history to kick start the transformation of cancer care on the continent. There are lessons to be learnt from the vulnerabilities of our public health systems from this Covid-19 pandemic,” she said.

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