At the World Cancer Congress my talk has been about universal health coverage, cancer control and palliative care and specifically looking at advocacy lessons from other fields of health and human rights and sharing some lessons from Uganda.
I think other challenges to advancing universal health coverage and cancer control in Uganda is the fact that we do not have a national health insurance scheme here. That for me is a major, major challenge because the fact remains that still families and patients have to pay out of pocket for some services. The cancer services, because these are delivered through the Uganda Cancer Institute, which is a government body, are really free but there are a few tests that have to be done out of the institute, maybe a CT scan and so on. Of course, for these patients have to pay. So I think the major challenge currently is the lack of a national health insurance scheme that can cover everyone.
How can advocacy lessons from other fields of health and human rights help in improving cancer care in Uganda?
As advocates we continue to demand and to really urge the government to put in place the national health insurance scheme. We do have a draft National Health Insurance Bill but it is still pending signature by the President. So we just have to continue advocating for this.
The other constraint is really the budget constraints of low-income development countries that there are so many priorities so the budget has to be divided into so many other priorities. So of course even funding becomes a challenge. Although the government is progressing, you can see progressive efforts towards financing the cancer institute. There are plans to decentralise cancer services from the centre to regional cancer centres, to [?] centre but also to ensure that services are closer to the people.
What are the future plans?
The integration of cancer care in all other services is very important, whether it is HIV/AIDS we need to be streamlining cancer care or cancer control because within the HIV/AIDS programmes people can understand issues around cancer, we can easily integrate prevention there and we can easily integrate early detection like it is for cervical cancer. So I think we need to integrate more, we need to integrate cancer care with other non-communicable diseases programmes – cardiovascular disease, diabetes – but we also need to integrate cancer care within primary healthcare so that the healthcare workers are able to catch the early signs and make referrals for management.
So, for me, integration is the way to go. When it comes to advocacy we need to get cancer control integrated in other advocacy movements. For instance, the HIV/AIDS movement in the country is strong and we can get cancer control within that. We have a vibrant women’s and feminist movement and we know that the top cancers in the country are cancers that affect women so we can integrate cancer control within the women’s movement, within the feminist movement. We have a vibrant movement on sexual reproductive health in the country, we can integrate it there. So, for me, the future is really integration.
What is decentralisation?
One of the key plans in the country is to decentralise cancer services by establishing regional cancer centres. This is a mandate given by law. What that means is that the Uganda Cancer Institute, which is at the centre, will establish regional centres and direct and manage these centres so that the services go closer to the people. Currently the majority, most of the patients, have to come to the city centre which is far for many. Also you can lose patients to follow-up because of issues like transport, issues like accommodation in the centre. So that decentralisation through the establishment of regional cancer centres that are for government is hoped to actually bring cancer services closer to the people and also reduce the congestion at the centre.
What is the role of the law in cancer control in Uganda?
The law has played a central role in strengthening cancer care in Uganda. Before 2016 the Uganda Cancer Institute was run under the National Referral Hospital and in 2016 the government passed an enabling law which is the Uganda Cancer Institute law. Now, this law made the institute an autonomous body and what does this mean? This means that the institute gets a vote in terms of budget allocation each year and it’s obvious that the vote for the institute has been growing each year.
It has also enabled the institute to, for instance, procure cancer medicines directly, saving time and also ensuring that it’s the quality that they really want to procure. It’s brought in many more collaborations because the institute has that capacity to make decisions quickly. Also this institute has been recognised or appointed, selected within the East African region, as the East African Oncology Centre of Excellency. This is coming with its autonomous status.
The other development is it has also attracted external financing, external support from other multilateral bodies like the African Development Bank. But it has also been accredited as an oncology institute for training in cancer control. So that enabling law, the Uganda Cancer Institute, has really enabled this institute to grow and growing with the expansion of cancer services, improvement of quality. But most importantly, also the law gives the institute a mandate to decentralise cancer services. So there is already progress being made to ensure that cancer services are decentralised to the different regions of the country. Of course, we are yet to get there; we need more collaborations to facilitate this. But, yes indeed, it’s a good plan and we have made progress on it.
In addition to that we also have the Tobacco Control Act of 2015, another law that can be enabling in terms of cancer control in the country. Although the implementation has been really slow, what our countries need is that technical support in terms of implementation of, say, tobacco control or how other countries are doing it. So that technical support, even support in terms of financial resources, because that’s where I see partnership can really benefit us as a country.
Anything else to add?
For me it is to emphasise that cancer control, UHC, are all human rights issues under the right to health. Indeed, beyond the advocacy we are doing, we need to be utilising opportunities such as public interest litigation to demand for the services, putting into consideration the standards for the right to health, accessibility, acceptability, quality of services, availability. So we need to use the human rights best approach more and we need to use the law much more in advancing cancer control and UHC.