6 research outputs found
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The Social Pain of Cancer in East Africa: Understanding Need
Cancer is both an individual physical, social and psychological crisis for a patient with one of the many forms of this category of non-communicable disease, and also a cause of deep social pain. Cancer spreads its tentacles through families and friends, social groups and the wider economy, generating stigma, financial destruction, social and psychological damage. This chapter makes the case for a very broad social understanding of cancer need, framing cancer as a whole-society problem, with psychological, social, economic and spiritual impacts much wider than the sufferer. This framing also implies greater attention to survivability and human dignity in policies, practices and provision
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Conclusion: Better Cancer Care and Greater Local Health Security: Lessons, Opportunities and Ways Forward
In pulling together the book’s analytical themes and practical lessons in the conclusion, this chapter emphasises as a core theme the scope for bringing together health, industrial development and innovation to build greater local health security, for cancer care, across the spectrum of health need and pandemic preparedness. The pandemic and our study of cancer care reinforced the importance of simultaneous co-resolution of challenges pertaining to health systems strengthening, development of broad industrial capabilities and improvements in planning, organisational, funding and institutional capabilities. This is critical for building agile and resilient local health security, a critical pre-condition for global health security
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Innovation and Policy in Cancer Pain Management: Systemic Interactions in Tanzania
In contrast to India, Tanzania imports all its opiate medication, yet there too, need is unmet. This chapter reports findings from a sustained collaborative effort in Tanzania to understand the roots of undertreatment of severe cancer pain. It analyses the complex sources of this cancer care failure, contrasting the Tanzanian situation to the Ugandan experience of providing more widespread access to opiate medication for severe pain. The chapter describes findings from multi-sectoral and multi-disciplinary workshops in Tanzania, documenting critical causal feedback loops that generate sustained undertreatment of severe pain, and identifies innovations that could turn this outcome around
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Cancer patients’ pathways: evidence and implications for policy
This Discussion Paper presents findings from a patients' pathways survey conducted in 2019 with 62 Tanzanian participants suffering from cancer or survivors of cancer. The paper looks at facilitators and barriers to accessing cancer care in Tanzania. A number of identified challenges that hinder patients from accessing care in a timely manner relate to costs, diagnosis and referrals. The paper highlights the social and economic burden faced by patients on the path to treatment. The research forms part of a larger collaborative project, Innovation for Cancer Care in Africa (ICCA).
The survey included an innovative methodology, tracing in detail patients’ pathways through their experience of cancer from first symptoms to diagnosis to treatment and after. Key findings in this paper include the following.
* Late-stage presentation of cancer is acknowledged to be a serious impediment to effective treatment in Tanzania. The average delay for these patients between first going to a health facility with symptoms that were those of cancer, to diagnosis, was 2.13years. This delay is a central cause of late stage presentation for treatment.
* In their search for a diagnosis, many patients have moved repeatedly between formal facilities as their (often severe) symptoms worsened. While most public sector patients had to move “up” the system, from district to zonal or national level hospitals to obtain a diagnosis, only 15% of all these movements between facilities were the result of a referral. Most were patients’ (and their families’) search for diagnosis.
* Regional hospitals, to which many patients moved from district level, did not do well in terms of diagnosis; only 8 people were eventually diagnosed at regional level including none who began their pathways at that level.
* Several patients had been well served by dispensaries and district hospitals: two directly diagnosed there, and several moving directly to the facility where diagnosed: there is thus some good practice at district level to be shared.
* Two patients were diagnosed through screening, both after several moves between formal health facilities, evidencing both the importance of screening and the lack of effective investigation of symptoms within the system.
* Out-of-pocket costs were high for patients in the period when they were seeking treatment, an average of over TZS 400,000. For those on lower household incomes in particular, this had imposed a major burden and source of impoverishment. This effect was worsened by the addition of transport costs of moving between facilities.
* Patients starting in the private sector, generally with NHIF or private insurance, experienced shorter and more direct trajectories to diagnosis. Insurance was only partially financially protective before diagnosis, reducing on average but not eliminating out of pocket (OOP) spending.
* Delays between diagnosis and treatment were much shorter: average 16 weeks to start of treatment. A cancer diagnosis triggered, on average, burdensome continuing costs: while half of respondents made no OOP payments after diagnosis, the average payments for all respondents were over TZS 1.6 million. Of those who made these payments, 80% had no insurance.
* Over half of respondents said they had used a complementary or alternative form of care. For many this was prayer and faith healing, sometime associated with other forms of mosque or church support. Those who went to alternative healers and gave cost details had spent an average of nearly TZS half a million.
* Free treatment at Ocean Road Cancer Institute (ORCI) is effective in protecting many lower income patients, who made up the majority of respondents interviewed at ORCI, from prohibitive costs of treatment, and is hugely appreciated by patients
Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis
Background: This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis.
Methods: Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases checkups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis.
Results: Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost.
Conclusions: Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care
Policy mapping: women's economic empowerment in Tanzania
This is one of the five country-based scoping papers commissioned by the International Development Research Centre (IDRC) to inform the foundations of the Growth and Economic Opportunities for Women (GrOW) East Africa Initiative.This scoping paper highlights policies, plans, and initiatives related to women’s economic empowerment in Tanzania. With expert knowledge of the policy landscape, the authors conducted a rapid assessment of available literature, covering eight themes relevant to women’s economic empowerment and gender equality. They identified gaps and entry points for further research to support evidence-based policies and programming, and stakeholders who may champion some of the work going forward