March 25, 2022

The Battle to Close the Cancer Care Gap and Upskill the Nursing and Midwifery Profession to Provide Specialist Cancer Care

March 25, 2022

The Battle to Close the Cancer Care Gap and Upskill the Nursing and Midwifery Profession to Provide Specialist Cancer Care

I was pleased to join the Bricon Foundation, Co-founders Dr Niyi Adekeye and Mrs Abigail Simon-Hart, Trustee Mrs Sonja Ally and special guest Dr Adamu Umar, President of the Nigerian Cancer Society at the launch of The Bricon Foundation’s new fundraising campaign “ E Fit B u” to raise 50 Million Naira for cancer patient treatment on Sunday, March 20th, 2022. 

Cancer remains the leading cause of death worldwide, accounting for nearly one in six deaths, and with a new case of cancer being diagnosed every 2 seconds, changing lives completely. In 2018, I and my Wellbeing Foundation Africa commissioned the Report of the Rapid Assessment of Cancer Care in Nigeria by The Wellbeing Foundation Africa (WBFA) on behalf of Amref Health Africa. As the statistics prove, cancer is a personal story for all of us, with us all being affected.

In February of this year, I lost a very close friend of mine, Dr Mwelecele Ntuli Malecela to cancer. She was a passionate advocate for eliminating neglected tropical diseases as Director of WHO’s Department of Control of NTDs. She was also a highly respected scientist, who specialised in lymphatic filariasis in Tanzania –  a truly inspirational figure for young women in science, a dedicated leader and a committed listener.

Unfortunately, cancer is a cruel and silent disease. It does not care about your age, gender, status, or personality to be diagnosed with it, but then to be treated for it, it does; the equity gap within cancer care is costing lives.  

People who seek cancer care hit barriers at every turn. Income, education, geographical location and discrimination based on ethnicity, race, gender, sexual orientation, age, disability and lifestyle, and the cancer care infrastructure and specialist nursing and midwifery workforce deficit are just a few of the factors that can negatively affect care. 

The most disadvantaged groups are also more likely to have increased exposure to a host of other risk factors, like tobacco, an unhealthy diet or environmental hazards. It is almost guaranteed that the cancer care gap affects you or people in your community. 

If we work collectively we can close the gap. The reality today is that who you are and where you live could mean the difference between life and death. It is not fair, but we can work to change this. We must bridge the gap and support organisations like Bricon in their admirable work to make the lives of people experiencing cancer and their families better and together, strive to make a difference in the Cancer Care landscape in Nigeria.

Nigeria suffers from high morbidity and mortality of cancer, with a 60 percent death rate. This rate is disturbing and extremely high. By improving the gaps that exist throughout the cancer care supply chain; from policy to health system capacity, screening and early detection to financing treatments, and the available workforce in cancer care to cancer survivors and family support, we can support the 40% while raising the overall survival rate. 

According to the Wellbeing Foundation Africa and Amref Health Africa’s landmark 2018 Rapid Assessment of Cancer Care in Nigeria – which guided Nigeria’s policymakers in formulating National Cancer Strategy and Registries – the burden and trend of non-communicable diseases – including cancer – is on the increase in Nigeria – and it is instructive that the research was supported not by any domestic resource mobilisation, but by an international donor, Takeda.

We found that most states had only one officer in their NCD unit who rarely comes to the workstation. Primary Health Cares have functional referral systems but most health workers in these facilities do not have the capacity to screen or make diagnoses at this level. The treatment in these facilities is not optimal because of inadequate financing, insufficient equipment and a low level of technical know-how in dealing with cancer. 

The supply chain of drugs and commodities are also very expensive, leading to the majority of the population experiencing a financial barrier to treatment. The report shows that at a stakeholders’ level, the awareness of cancer is low, and according to the health workers, most of the patients present themselves to the health centres when cancer is at stage 3 or 4 when nothing much can be done beyond palliative care and counsel. 

The cancer care landscape in Nigeria is compounded with an acute shortage of health personnel, due to the ongoing brain drain of health personnel to high-income countries. For example, Clinical Nurse Specialists in Nigeria are long overdue for the development, recognition, and legal inclusion of the Midwifery and CNS roles and practices in the career structure of nurses at all levels of the health system and Midwifery Services Framework. 

In collaboration with national and international partners, my Wellbeing Foundation Africa’s Cancer Alliance is now committed to formulating a road map towards an important Push Policy that would: train, recognize and remunerate advanced degree nurses and Midwives in the clinical settings with appropriate salary scale; establish standards for CNS role and practice; and develop the CNS curriculum with master’s level courses that include opportunities for content-specific clinical experiences such as specialist training for cancer nursing.

The Bricon Foundation recognises the lack of sufficient support structure (counselling and advice), equipment, financial assistance and trained medical personnel to cope with the ever-increasing numbers of cancer patients. 

Whilst screening and advocacy continue to bring cancer patients to the fore, the treatment and support structures cannot cope with these rising volumes. There is, therefore, a need to address the different areas of cancer care to ensure that patients who are found to have cancer, have choices of where to go to receive care, and more importantly can afford to have this care at all.

We cannot overemphasise the importance of having the relevant medical infrastructure within the country, supported by well-trained motivated professionals and appropriate legislation. This can only be done if there is sufficient funding to the medical sector as a whole and if there are funding mechanisms to make more complex specialist care such as cancer treatment available to all citizens and not just the wealthy and informed.

Helping raise awareness about cancer via education, advocacy and counselling, caring about the emotional well-being of those with cancer,  and supporting fundraising for treatment, equipment and training are all necessary for the continued fight against cancer. 

In 2022, the Bricon Foundation remains committed to improving the quality of care available to cancer patients through support for the purchase of much-needed cancer drugs and medicaments, funding for treatment and diagnostic tests as well as much-needed emotional support to them and their families. They will also resume training programmes for healthcare workers in Breaking Bad News, end of life and Palliation.

This battle requires a holistic approach, including increasing the awareness about the disease; educating on screening and early diagnosis; training and retraining of relevant health workers; and infrastructure upgrade in our facilities across the country.

Let us all support Bricon in their commendable work to make sure cancer patients, survivors and their families are supported in all stages of this disease by contributing to the Bricon Foundation’s target of Raising 50 million Naira so that we can support the Foundation in this mission. 

Since I am committed to the cause of upskilling the nursing and midwifery profession to provide specialist care, I am working towards mobilising resources to create a dedicated grant to support the Bricon Foundation’s Macmillan based services. 

We may not cure cancer today, but we can contribute to the battle against it by doing what we can to support closing the care gap today!

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