Assessing Uganda’s compliance with cancer declaration goals 

The Uganda Cancer Institute at Mulago hospital. A specialised facility to handle cancer cases is key to ensuring the right treatment is given to patients. PHOTO | FILE

What you need to know:

  • The declaration recommended fulfilment of the targets by 2020; and further outlined priority steps that need to be taken in order to meet the set targets.
  • The targets and some of the measures put in place by the government include:

In September 2008, a summit of more than 60 high-level policy makers, 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 fulfil.

The declaration recommended fulfilment of the targets by 2020; and further outlined priority steps that need to be taken in order to meet the set targets.
The targets and some of the measures put in place by the government include:

Strengthening health systems
The target to have health systems strengthened to ensure sustained delivery of effective and comprehensive, patient-centered cancer control programmes across the life course.

Measuring cancer burden and impact 
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) was developed with a focus on increasing research outputs.

Reducing exposure to 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, the passing of a comprehensive tobacco control law in 2015 to reduce tobacco use and exposure to second-hand smoke. Although its implementation is still wanting, the President launched physical activity day to reduce physical inactivity as well as curbing non-communicable disease risk factors.

However, measures to reduce alcohol intake are yet to be realised with the ban on sachet waragi which is yet to be effected.

Universal coverage of HPV and HBV vaccination
A target that sought to have cancer-causing infections human papillomavirus (HPV) and hepatitis B virus (HBV) covered by universal vaccination programmes.  

Uganda has complied through the Ministry of Health and has since it issued two statutory instruments to advance the fight against hepatitis B, whose virus is responsible for 80 per cent of liver cancers, reported at Mulago hospital alone, annually. 

Liver cancers form two per cent of the admissions at Uganda Cancer Institute, as noted in the 2018 World Hepatitis Day press statement on the progress of implementation of Hepatitis B vaccination programme in Uganda.. 

Declaration of Hepatitis B as a formidable epidemic  
Dr Alfred Driwale, the assistant commissioner in charge of vaccines and immunisation at the Ministry of Health, notes that they (ministry) set elimination targets in 2015 to fight hepatitis B, one of major causes of liver cancer. 
 
“The target was and still is that by 2030, hepatitis B prevalence in children between 0-5 years should be at 0.1 per cent, meaning that when 1,000 children in the age group are tested only one would be positive for Hepatitis B,” Dr Driwale, told Daily Monitor in a telephone interview.
He noted that the performance is good with 92 per cent of the children started on the vaccine completing their dosage.

“We appeal to stakeholders such opinion leaders, media, parents and the entire communities of Uganda to join us in this battle of eliminating cancer through vaccination because a collective effort will see a zero hepatitis B case in 6-7 years from now,” he said.

However, adult vaccination is still low. The government seems to leave the battle to private healthcare providers yet many cannot afford the costs. 

According to the 2016 Uganda Population-based HIV Impact Assessment (UPHIA) survey, prevalence of Hepatitis B infection among adults stands at 4.3 per cent (5.6 per cent among men and 3.1 per cent among women). 

The survey indicates that hepatitis B prevalence is highest in Northern region with 4.6 per cent in mid-North, 4.4 per cent in north-east and 3.8 per cent in West Nile. 

Regarding HPV vaccination, to abet cervical cancer, which is the leading cause of cancer morbidity and mortality among Ugandan women, the government in November 2015 launched a nationwide HPV vaccination, targeting girls aged 10-13 years. 

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

Action on this, according to Uganda Cancer Society 2016 report in which it captured progress towards the targets, is the inclusion of civil society and private sector actors in raising public awareness of cancer to demystify cancer, which remains a mystery.

Cancer fighting organisations are doing their best to intensify awareness-raising efforts nationally to help dispel myths around cancer and provide life-saving information on screening and early detection.
However, Mr Moses Muwulya, a cancer awareness activist in Masaka says  there is need for government to be at the fore front of this.

“Ignorance about cancer is the first cancer we need to cure and then deal with other cancer types,” Mr Muwulya, who lost a daughter to eye cancer,  says.
 
Universal access to screening and early detection
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 symptoms.
 
Improving access to services
Access to accurate cancer diagnosis, quality multi-model treatment, rehabilitation, supportive and palliative care services, including the availability of affordable essential medicines and technologies, will have improved.

Developing treatment infrastructure, including the construction of a new cancer ward, and a radiotherapy centre.

The Uganda Cancer Society (UCS) would welcome the establishment of a functional cancer control programme, with an emphasis on prevention, alongside specific national indicators for cancer within the NCD plan.

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.

However, meeting this target remains the sole work of non-governmental organisations which offer palliative care, counselling and sensitisation although government efforts to heed to the above target remains ambiguity.

Improving 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.

There is also a need to significantly invest in the human resources available to manage cancer and decentralise services, include tabling a Cancer Control Bill in Parliament, and the allocation of a dedicated budget to cancer activities.