SUSTAINING ACCESS TO HIGH QUALITY RADIOTHERAPY CARE: … · Cervix. Breast. Bladder. Esophagus....
Transcript of SUSTAINING ACCESS TO HIGH QUALITY RADIOTHERAPY CARE: … · Cervix. Breast. Bladder. Esophagus....
-
SUSTAINING ACCESS TO HIGH
QUALITY RADIOTHERAPY
CARE: A LMIC PERSPECTIVE
Dr Kennedy Lishimpi BSc MB ChB M.Med FC Rad Onc (SA)
Director Cancer Control Ministry of Health
Zambia
ICARO2 21/06/17
-
Introduction
• Population 15.5M • Below 24 years 66% • Median Age 16.7Yrs • Growth Rate 2.94% • Rural Population 59% • Life Expectancy 52.5Yrs • Literacy 63.4%
Mission Statement: To provide equitable access to cost effective, quality health services as close to the family as possible Vision: A Nation of Healthy and Productive People
Overall Goal: To improve the health status of people in Zambia in order to contribute to socio-economic development Key Principles: Primary Health Care (PHC) approach; Equity of access; Affordability; Cost-effectiveness; Accountability; Partnerships; Decentralisation and Leadership
-
Republic of Zambia
Access to Radiotherapy
Care
PresenterPresentation NotesAt Bellagio, we were invited by Dr. Emmanuel Makasa…We are at the beginning of a very long process…As we said many times in the Commission report, every country is different, and context specificity to recommendations is criticalThese slides represent simply an initial application of the LCoGS report methodologies to one specific country, here Zambia, to begin the conversation on how to strengthen surgical servicesZambia is a lower-middle-income country by WB income group
-
The Radiotherapy Dream
• The vision to establish a radiotherapy center in Zambia started in 1982.
• Due to the increasing numbers of cancer cases seen, Zambia needed to establish its own specialist hospital
• To reduce costs and Increase access to treatment to more people.
• Due to lack of budgetary allocation the project was delayed for many years.
-
The Dream cont.
• 1995, there was a firm plan by GRZ to establish cancer centre at UTH in collaboration with IAEA
• GRZ to construct building, and IAEA to provide equipment and training of staff
• GRZ was to contributed K100m ($25000) for the project
• Project did not take off
-
Dream cont’
• April 2001, GRZ Submitted Project Proposal to OFID
• June 2001, Project Appraissal Mission followed by approval By OFID in August 2001.
• September 2002 Loan Became Effective • Contracts for construction and equipment
signed in 2003.
-
Cancer Diseases Hospital During Construction Phase
• Before 2006 GRZ had been sending cancer patients abroad.
• At $10 000 per patient • Due to limited budget
allocations for treatment abroad, only 350 cases out of 5,000 were sent between 1995 and 2004
• Construction started 2003
-
ZAMBIA CANCER CONTROL PROGRESS • 1982 ZNCR set up • 2006CANREG introduced • 2012 Population Based Registry for Lusaka Province • 2006 Cancer Diseases Hospital Completed and officially opened on 19th July 2007 • 2009 1ST QUATRO MISSION • 2010 IMPACT MISSION • 2016 CDH Phase II complete • 2017 Construction of two radiotherapy satellite centers • 2006 cervical cancer screening set up • 2012 HPV vaccination introduced • 2013 cervical cancer screening available in all provinces • 2018 national HPV vaccine scale up
• 2016 National Cancer Control Strategy 2017 – 2021 signed
-
Proportion of deaths by cause in SSA, 2010
4%
12%
13%
23%15%
25%
3%
6%
Tuberculosis
HIV/AIDS
Malaria
Other communicable diseasesMaternal,perinatal and nutritional causesNoncommunicable diseasesRoad traffic injuries
Other injuries
Health Observatory Data Repository: http:/apps.who.int/ghodata
-
Proportion of mortality by cause in
Zambia in 2014
-
Overall Cancer Problem in Zambia
• The overall age-standardized cancer incidence rate for both sexes in Zambia in 2012 was 136.2 per 100,000 (10,593 cases) for all cancers
• The age-standardized mortality rate to be 104.9 per 100,000 (7,521 deaths)
• This means that the majority (71%) of new cancer cases in Zambia die from the disease.
-
Challenges of Accessing Quality Radiotherapy Care in LMIC
• Inadequate primary and secondary prevention national programmes ( Late Presentations )
• Underfinanced or poorly resourced cancer care activities (from Community to TC)
• Inadequate trained Human Resource
• Poor Infrastructure • Lack of appropriate
equipment and its maintenance
-
RADIOTHERAPY SERVICES IN ZAMBIA
YEAR ACTIVITY & OUTPUT
2001 7 Million USD set aside OFID/IAEA/GRZ for the development of the first radiotherapy centre in Zambia – Phase I
2012 8 Million USD set aside OFID/GRZ for construction of CDH Phase II
2016 25 Million USD has been set aside BADEA/OFID/GRZ for the development of the first two satellite centers in Zambia Phase III
YEARLY Parliament appropriates money for running costs and cancer medicines and supplies on yearly basis
-
CDH Today • CDH Phase I & II:
– 252 in-patient department – 8 bed Nuclear Medicine unit – Theatre Block – Out-patient department – Chemotherapy unit with 80
beds – Radiotherapy area – Mould room and workshop – Pharmacy unit – Diagnostic wings X-Rays,
MRI, CT MMG, US & various Lab equipment
– Administration block
-
CDH Phase II Chemo & Ward
-
Cobalt 60 & Linear Accelerator
-
Treatment Planning & Second Cobalt 60 Unit
-
2 High Dose Rate Brachytherapy Units
-
Simulator & CT Scanner
-
Mammogram & MRI
-
PROGRESS SINCE QUATRO MISSION 1. EQUIPMENT
2009 QUATRO FINDINGS PROGRESS 2017 COMMENT
1 linear accelerator STILL 1 PLANNED TO BUY ONE AND REPLACE 2006 ONE LATER
1 Cobalt 60 2 DONE UNDER CDH PHASE 2
1 Orthovoltage (Not working) 1 DECOMMISSIONED
1 High Dose Rate brachytherapy unit 2 DONE UNDER CDH PHASE 2
Treatment Planning System (Not in use)
STILL NOT IN USE THERAPLAN CANNOT BE FIXED OUTDATED
1 Conventional Simulator 1 OUT OF USE PROCURED A CT SIM TO BE READY BY SEPTEMBER 2017
Mould Room and workshop. STILL SAME
-
PROGRESS SINCE QUATRO MISSION 1. EQUIPMENT
2009 QUATRO FINDINGS PROGRESS 2017 COMMENT Mammography 1 1 Working Ultrasound 2 2 Working Laboratory equipment Functional X –Ray Unit 0 1 Digital Fluoroscopy unit CT Scanner 1Planned 1 Functional MRI Scanner 1Planned 1 Functional Nuclear Medicine Treatment Units Planned
Available Full complement
2009 QUATRO FINDINGS
PROGRESS 2017
COMMENT
Mammography 1
1
Working
Ultrasound 2
2
Working
Laboratory equipment
Functional
X –Ray Unit 0
1
Digital Fluoroscopy unit
CT Scanner 1Planned
1
Functional
MRI Scanner 1Planned
1
Functional
Nuclear Medicine Treatment Units Planned
Available
Full complement
-
PROGRESS SINCE QUATRO MISSION 1. HUMAN RESOURCE
2009 QUATRO FINDINGS PROGRESS 2017 COMMENT Total Staff 131 (86 Clinical) 410/752 (281 Clinical Staff) NEWLY APPROVED
ESTABLISHMENT ROs 5 + 6 7 + 10 3 Training in RSA and 16 will
start training at CDH M.Med Clin Onc
SO, GO, PO 0 4 + 3 3 Employed and all going to TMH for 12 months training
NMP 0 2 In training in RSA MPs 3 5 + 1 3 Complete 2 doing clinical
training 1 just joined RTTs 13 35 Lab Techs 4 11 Pharmacy 6 24 Nurses 31 162
2009 QUATRO FINDINGS
PROGRESS 2017
COMMENT
Total Staff 131 (86 Clinical)
410/752 (281 Clinical Staff)
NEWLY APPROVED ESTABLISHMENT
ROs 5 + 6
7 + 10
3 Training in RSA and 16 will start training at CDH
M.Med Clin Onc
SO, GO, PO 0
4 + 3
3 Employed and all going to TMH for 12 months training
NMP 0
2
In training in RSA
MPs 3
5 + 1
3 Complete 2 doing clinical training 1 just joined
RTTs 13
35
Lab Techs 4
11
Pharmacy 6
24
Nurses 31
162
-
ZNCR CONSOLIDATED REPORT 2008 - 2014
• Total cases = 17,795 • Female = 11,451 • Male = 6,344
-
Top Ten Cancers in Males 2008 – 2014
0 200 400 600 800 1000 1200 1400 1600
Kapsoi Sarcoma
Prostate
Esophagus
Eye
Non Hodgkin Lymphoma
Liver
Bladder
Stomach
other skin
Penis
Tiop Ten-Male Top Ten-MaleKapsoi Sarcoma 1513 23.85%Prostate 1387 21.86%Esophagus 331 5.22%Eye 324 5.11%Non Hodgkin Lym 274 4.32%Liver 239 3.77%Bladder 233 3.67%Stomach 196 3.09%other skin 156 2.46%Penis 148 2.33%
-
Top Ten Female Cancers 2008 – 2014
6009
1119
972
369
244
206
196
185
171
171
157
0 1000 2000 3000 4000 5000 6000 7000
Cervix
Breast
Kaposi sarcoma
Eye
Non Hodkin Lymphoma
Ovary
Bladder
Esophagus
Stomach
Other vSkin
Liver
Top Ten-Female TOP TEN-FEMALECervix 6009 52.48%Breast 1119 9.77%Kaposi sarcoma 972 8.49%Eye 369 3.22%Non Hodkin Lymp 244 2.13%Ovary 206 1.80%Bladder 196 1.71%Esophagus 185 1.62%Stomach 171 1.49%Other vSkin 171 1.49%Liver 157 1.37%
-
Provincial Distribution Cases Per ProvinceCentral 1568Copperbelt 1875Eastern 2228Luapula 710Lusaka 6821Muchinga 511North Western 613Northern 808Southern 1542Werstern 872Unknown 247Total 17795
1568
1875
2228
710
6821
511
613
808
1542
872 247
Total Cases Per Province
Central Copperbelt Eastern Luapula
Lusaka Muchinga North Western Northern
Southern Werstern Unknown
-
Childhood Cancer Registration in Zambia, 2013
Cancer Type 0-4 5-9 10-14 Total Liver 0 0 3 3 Bone 1 4 5 10 Kaposi sarcoma 7 8 6 21 Kidney 15 11 1 27 Retinoblastoma 25 6 0 31 Brain/Nervous system 3 4 1 8 Hodgkin Lymphoma 3 3 3 9 Burkitt lymphoma 1 3 0 4 Non hodgkin lymphoma 1 1 0 2 Leukeamia 1 6 5 12 Skin 1 0 1 2 Eye 1 3 4 8 Other 3 3 4 10 Total 62 52 33 147
-
CDH Statistics for 2015Years # of
pts
2006 35
2007 719
2008 1204
2009 1285
2010 1282
2011 1302
2012 1828
2013 2049
2014 2065
20152058
Total 13827
0
500
1000
1500
2000
2500
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
cancer trends in the last four years have maintained a stable balance. This could be attributed to inadequate sensitizations to the community through various medias
CDH Statistics for 2015
Years # of pts
200635
2007719
20081204
20091285
20101282
20111302
20121828
20132049
20142065
20152058
Total13827
cancer trends in the last four years have maintained a stable balance. This could be attributed to inadequate sensitizations to the community through various medias
Series 120062007200820092010201120122013201420153571912041285128213021828204920652058
-
Top 10 cancers for Both Males & Females - 2013
0
5
10
15
20
25
30
35
05
10152025The mean age is 47
The ratio between Male 687 to Female 1349 = 1:2
-
Republic of Zambia
Sustaining Radiotherapy
Services in Zambia
PresenterPresentation NotesAt Bellagio, we were invited by Dr. Emmanuel Makasa…We are at the beginning of a very long process…As we said many times in the Commission report, every country is different, and context specificity to recommendations is criticalThese slides represent simply an initial application of the LCoGS report methodologies to one specific country, here Zambia, to begin the conversation on how to strengthen surgical servicesZambia is a lower-middle-income country by WB income group
-
National Cancer Control Strategic Plan 2016 - 2021
• Developed, signed by Minister of Health August 2016and Launched February 4th 2017
• Director Cancer Control Unit Appointed with the Coordination Unit
• Cost plan for five years
-
Improving Access to Radiotherapy in Zambia
-
IAEA TECHNICAL COOPERATION
• ZAM 6010 – Establishing the First Radiotherapy Centre in Zambia
• ZAM 6012 – Improving the Quality of Cancer Treatment • ZAM 6016 – Strengthening the Delivery of Radiotherapy
Services • ZAM 6019 – Expanding the Capacity for Radiation Oncology
through Sustainable Local Human Resource Development to Benefit National Cancer Control
• ZAM 6020 – Consolidating the Delivery of Cancer Treatment Services
-
HRH Development
• Established RTT TEVETA accredited Diploma, First students started June 2012
• CDH Training College – M.Med Clinical & Radiation Oncology – BSc Therapy Radiography – BSc Oncology Nursing – MSc Medical Physics
-
IN-SERVICE PRE-SERVICE
PREVENTION 1. Community Health Workers (Cancer Skills Package)
EARLY DETECTION 2. Screening Workers (Cervical Cancer: VIA)
DIAGNOSIS & TREATMENT
3. Pathology Technicians 4. Surgeons (Surgical Oncology Modules)
5. Radiation Therapy Technicians 6. Clinical Oncologists 7. Oncology Nurses 8. Pathologists
PALLIATIVE CARE 9. Palliative Care practitioners (Short Courses)
SURVEILLANCE 10. Data Collectors*
VUCC: An instrument for access to Cancer Control Education & Training at home
-
Thank You!
Slide Number 1Slide Number 2IntroductionSlide Number 4The Radiotherapy DreamThe Dream cont.Dream cont’Cancer Diseases Hospital During Construction PhaseZAMBIA CANCER CONTROL PROGRESSProportion of deaths by cause in SSA, 2010�Proportion of mortality by cause in Zambia in 2014�Overall Cancer Problem in ZambiaChallenges of Accessing Quality Radiotherapy Care in LMICRADIOTHERAPY SERVICES IN ZAMBIACDH TodaySlide Number 16CDH Phase II Chemo & WardCobalt 60 & Linear AcceleratorTreatment Planning & Second Cobalt 60 Unit2 High Dose Rate Brachytherapy UnitsSimulator & CT ScannerMammogram & MRI PROGRESS SINCE QUATRO MISSION�1.EQUIPMENTPROGRESS SINCE QUATRO MISSION�1.EQUIPMENTPROGRESS SINCE QUATRO MISSION�1.HUMAN RESOURCEZNCR CONSOLIDATED REPORT �2008 - 2014Top Ten Cancers in Males �2008 – 2014 Top Ten Female Cancers �2008 – 2014 Provincial DistributionChildhood Cancer Registration in Zambia, 2013Slide Number 31Top 10 cancers for Both Males & Females - 2013 Slide Number 33National Cancer Control Strategic Plan 2016 - 2021Improving Access to Radiotherapy in ZambiaIAEA TECHNICAL COOPERATIONHRH DevelopmentSlide Number 38Slide Number 39