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Priorities for cancer diagnosis and treatment in Zimbabwe

include the establishment of cancer multidisciplinary teams,

updating cancer treatment guidelines, the decentralization

of diagnostic and treatment services and making

accommodation available for patients being treated. Services

should focus on early detectable tumours. Training of primary

care staff to support decentralization should be

implemented.

Palliative care and rehabilitation

WHO defines palliative care as "an approach that improves

the quality of life of patients and their families facing the

problems associated with life-threatening illnesses, through

the prevention and relief of suffering by means of early

identification and impeccable assessment and treatment of

pain and other problems, physical, psychosocial and

spiritual".12

The provision of palliative care was pioneered in Zimbabwe

by Island Hospice in 1979 and initially mainly served patients

with cancer. Thereafter, service provision widened to include

patients with other chronic conditions such as AIDS in

response to the demand of the heightened epidemic. To

optimize coverage, more emphasis was put on communitybased services throughout the country.

The Hospice and

Palliative Care Association of Zimbabwe (HOSPAZ) was

established to support and promote palliative care services in

collaboration with the Ministry of Health and Child Welfare.

In 2004, through a pilot project which included five African

countries, WHO estimated the proportion of people needing

palliative care to be 1 in 60. Also noted was the low level of

integration of palliative care into the health care system.

Subsequent review by the African Palliative Care Association

(APCA) in 2010 showed Zimbabwean palliative care services

to have progressed. The following had been achieved:

‰ There was a critical mass of activists and a range of

providers and service types.

‰ Palliative Care was integrated into mainstream service

provision, research was being undertaken and a national

association had been formed.

‰ Palliative care provision is now part of the National

Health Strategy and standard palliative care guidelines

are already in use.

Palliative care priorities for the future include funding of

local programmes, ensuring availability of morphine at all

times and training primary health care workers and

community-based carers in palliative care. Underpinning all

of the above is finalization and approval of the guidelines by

the Ministry of Health and Child Welfare. The existing draft

palliative care policy which seeks to address pain

management, psychosocial and cultural needs of all people

living with cancer needs to be implemented. Rehabilitation

for cancer patients should also be prioritized.

Cancer surveillance and research

A cancer surveillance programme is an essential part of any

national cancer control programme. Evaluation of the current

situation, setting objectives for cancer control and defining

priorities, and later, monitoring the implementation of the

many individual cancer control activities is mandatory.

Zimbabwe has a population-based cancer registry mainly for

Harare. Funds permitting, a priority should be extension of

this to the provinces. To achieve this goal, skilled personnel

will need to be trained to implement expanded surveillance

services. Legislation to make cancer a notifiable disease will

go a long way to improving cancer registration. Ongoing

integration with other surveillance systems for noncommunicable diseases and HIV will improve

efficiency and

avoid duplication of processes. Statistical data to be

prioritized includes data on incidence, mortality, stage

distribution, HIV status, treatment patterns and survival.

These will provide a basis for studies into the important

causes of cancer in the local situation and for providing

information about the prevalence of exposure to these

factors in the population.2

Additionally, prioritizing investment into research and

increased collaboration between relevant stakeholders will

optimize research efforts.

Programme priorities for cancer control in

Zimbabwe

Sourcing and allocation of funds to finance these various

activities is the cornerstone of a successful programme and

there should be a dedicated national cancer control budget. A

comprehensive cancer prevention and control policy needs

to be developed. It is recommended that there be a separate

cancer-governing body with representation at provincial,

district and community level, to facilitate communication and

coordination and to streamline efforts towards the fight

against cancer. Similar structures led to success of HIV care.

Such a cancer control strategy should be implemented in

2014. The strategy should comprise comprehensive cancer

referral and management guidelines, together with

guidelines for decentralization and comprehensive cancer

control. The latter also need to be integrated with primary

health care for adults and children, school and work

programmes, care for patients with other non-communicable

diseases and HIV and AIDS programmes. Aligning the existing

REGIONAL INITIATIVES

CANCER CONTROL 2014 129

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