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Nakaganda A, Lasebikan N, Garton EM, Kithaka B, Garanganga E, Livinski AA, Cira MK. COVID-19 exposed pre-existing roadblocks for cancer control in Africa: strategies, lessons and recommendations from the 2019–2020 Africa Cancer Research and Control ECHO. Ecancermedicalscience 2023. [DOI: 10.3332/ecancer.2023.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Nakaganda A, Lasebikan N, Garton EM, Kithaka B, Garanganga E, Livinski AA, Cira MK. How COVID-19 exposed pre-existing roadblocks for cancer control in Africa: strategies, lessons and recommendations from the 2019-2020 Africa Cancer Research and Control ECHO. Ecancermedicalscience 2023; 17:1516. [PMID: 37113714 PMCID: PMC10129397 DOI: 10.3332/ecancer.2022.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Indexed: 04/29/2023] Open
Abstract
Background The COVID-19 related mitigation measures adversely affected various cancer control activities in Africa, with cancer prevention and screening activities amongst the most significantly impacted. When the COVID-19 pandemic struck, the Africa Cancer Research and Control ECHO utilised their virtual platform to share experiences and knowledge of how to continue cancer service delivery during the pandemic. This analysis describes the evolved strategies, dilemmas, and recommendations to strengthen the health systems for cancer control in Africa. Methods Eleven 1-hour-long sessions about the then newly emerging coronavirus infection and its impact on cancer control in Africa were held from April 2020 to August 2020, using Zoom®. An average of 39 participants attended the sessions including scientists, clinicians, policymakers and global partners. Sessions were analysed thematically. Results Most strategies to maintain cancer services during the COVID-19 pandemic centred around cancer treatment, with few strategies on maintaining cancer prevention services, early detection, palliative care and research services. The most mentioned challenge during the pandemic was fear of exposure to COVID-19 infection at the health facility during diagnosis, treatment or follow-up for cancer care. Other challenges were disruptions to service delivery, inaccessibility of cancer treatment, disruption of research activities and a lack of psychosocial support for COVID-19 related fear/anxiety. Significantly, this analysis shows that the COVID-19 related mitigation measures exacerbated existing predicaments in Africa, such as inadequate attention to cancer prevention strategies, psychosocial and palliative services and cancer research. The Africa Cancer ECHO recommends African countries to leverage the infrastructure developed in response to COVID-19 pandemic to strengthen the health system along the entire cancer control continuum. This calls for urgent action to develop and implement evidence-based frameworks and comprehensive National Cancer Control Plans that will withstand any future disruptions.
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Affiliation(s)
| | - Nwamaka Lasebikan
- University of Nigeria Teaching Hospital, 8F26+HQ2, Enugu 402109, Nigeria
| | - Elise M Garton
- Center for Global Health, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Benda Kithaka
- KILELE Health Association, PO Box 1627, Nairobi, Kenya
| | - Eunice Garanganga
- Hospice and Palliative Care Association of Zimbabwe, 13 Lezard Avenue, Milton Park, Harare, Zimbabwe
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, NIH, 10 Center Drive Building 10, Room 1L-25, MSC 1150, Bethesda, MD 20892, USA
| | - Mishka K Cira
- Center for Global Health, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD 20850, USA
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Namisango E, Allsop MJ, Powell RA, Friedrichsdorf SJ, Luyirika EBK, Kiyange F, Mukooza E, Ntege C, Garanganga E, Ginindza-Mdluli MN, Mwangi-Powell F, Mondlane LJ, Harding R. Investigation of the Practices, Legislation, Supply Chain, and Regulation of Opioids for Clinical Pain Management in Southern Africa: A Multi-sectoral, Cross-National, Mixed Methods Study. J Pain Symptom Manage 2018; 55:851-863. [PMID: 29155288 DOI: 10.1016/j.jpainsymman.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 11/23/2022]
Abstract
CONTEXT Sub-Saharan Africa faces an increasing incidence and prevalence of life-limiting and life-threatening conditions. These conditions are associated with a significant burden of pain linked to high morbidity and disability that is poorly assessed and undertreated. Barriers to effective pain management partly relate to lack of access to opioid analgesia and challenges in their administration. OBJECTIVES To identify country-specific and broader regional barriers to access, as well as the administration of opioids, and generate recommendations for advancing pain management in Southern Africa. METHODS A parallel mixed methods design was used across three countries: Mozambique, Swaziland, and Zimbabwe. Three activities were undertaken: 1) a review of regulatory and policy documentation, 2) group interviews, and 3) a self-administered key informant survey. RESULTS Barriers to accessing opioid analgesics for medical use include overly restrictive controlled medicines' laws; use of stigmatizing language in key documents; inaccurate actual opioid consumption estimation practices; knowledge gaps in the distribution, storage, and prescription of opioids; critical shortage of prescribers; and high out-of-pocket financial expenditures for patients against a backdrop of high levels of poverty. CONCLUSION Policies and relevant laws should be updated to ensure that the legislative environment supports opioid access for pain management. Action plans for improving pain treatment for patients suffering from HIV or non-communicable diseases should address barriers at the different levels of the supply chain that involve policymakers, administrators, and service providers.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda; Uganda and King's College London, Cicely Saunders Institute, London, UK.
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Stefan J Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emmanuel B K Luyirika
- African Palliative Care Association, Kampala, Uganda; Uganda and King's College London, Cicely Saunders Institute, London, UK
| | - Fatia Kiyange
- African Palliative Care Association, Kampala, Uganda; Uganda and King's College London, Cicely Saunders Institute, London, UK
| | | | | | | | | | | | | | - Richard Harding
- King's College London, Cicely Saunders Institute, London, UK
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Luyirika EBK, Namisango E, Garanganga E, Monjane L, Ginindza N, Madonsela G, Kiyange F. Best practices in developing a national palliative care policy in resource limited settings: lessons from five African countries. Ecancermedicalscience 2016; 10:652. [PMID: 27563347 PMCID: PMC4970625 DOI: 10.3332/ecancer.2016.652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 11/06/2022] Open
Abstract
Given the high unmet need for palliative care in Africa and other resource limited settings, it is important that countries embrace the public health approach to increasing access through its integration within existing healthcare systems. To give this approach a strong foundation that would ensure sustainability, the World Health Organisation urges member states to ensure that policy environments are suitable for this intervention. The development, strengthening, and implementation of national palliative care policies is a priority. Given the lack of a critical mass of palliative care professionals in the region and deficiency in documenting and sharing best practices as part of information critical for regional development, policy development becomes a complex process. This article shares experiences with regard to best practices when advocating the national palliative care policies. It also tells about policy development process, the important considerations, and cites examples of policy content outlines in Africa.
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Affiliation(s)
- Emmanuel BK Luyirika
- African Palliative Care Association, PO Box 72518, Plot 95, Dr Gibbons Road, Kampala, Uganda
| | - Eve Namisango
- African Palliative Care Association, PO Box 72518, Plot 95, Dr Gibbons Road, Kampala, Uganda
| | - Eunice Garanganga
- Hospice and Palliative Care Association of Zimbabwe, 13 Lezard Avenue, Milton Park, Harare, Zimbabwe
| | - Lidia Monjane
- Mozambique Palliative Care Association, Av Eduardo Mondlane NR 540, BR Polana 0101, Maputo, Mozambique
| | - Ntombi Ginindza
- Swaziland National AIDS Programme, Ministry of Health, PO Box 1119, Mbabane, H100, Swaziland
| | - Gugulethu Madonsela
- Swaziland National AIDS Programme, Ministry of Health, PO Box 1119, Mbabane, H100, Swaziland
| | - Fatia Kiyange
- African Palliative Care Association, PO Box 72518, Plot 95, Dr Gibbons Road, Kampala, Uganda
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Harding R, Simms V, Krakauer E, DeLima L, Downing J, Garanganga E, Green K, Gwyther L, Lohman D. Quality HIV Care to the End of life. Clin Infect Dis 2011; 52:553-4; author reply 554. [DOI: 10.1093/cid/ciq180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Harding R, Powell RA, Downing J, Connor SR, Mwangi-Powell F, Defilippi K, Cameron S, Garanganga E, Kikule E, Alexander C. Generating an African palliative care evidence base: the context, need, challenges, and strategies. J Pain Symptom Manage 2008; 36:304-9. [PMID: 18722312 DOI: 10.1016/j.jpainsymman.2008.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 04/15/2008] [Accepted: 04/26/2008] [Indexed: 11/30/2022]
Abstract
The enormous burden of progressive, incurable disease in sub-Saharan Africa is reflected in the epidemiology of cancer and HIV. However, there has been little research activity and evidence generated to inform appropriate and effective responses. A collaborative of clinicians, academics and advocates have been active in the design, delivery and reporting of research activities in African palliative care. Here, they report the methodological, ethical, logistic and capacity-based challenges of conducting research in the sub-Saharan context from their experience. A number of strategies and responses are presented.
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Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London School of Medicine, London, United Kingdom.
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