What does the cancer workforce look like in Africa?

Prof Nazik Hammad - University of Toronto, Toronto, Canada

Can you tell us about the background of your topics today?

One of the main themes for this conference was on the workforce; it was about implementation, workforce and opportunities. So, given our previous work in the Education and Training Committee, we wanted to also concentrate on the workforce as part of the theme. So hence the keynote, which was basically trying to look at what the cancer workforce would look like in Africa in 2023.

Based on what the WHO recent Workforce Triad to optimise the workforce globally which is protect, protect the workforce, invest in the workforce, and also together, we should come together to make that happen, I concentrated in my keynote on the investment in the workforce. The reason for that is really cancer is a major threat now in Africa and the workforce are the major resource that is going to do all the work that is needed all the way across the continent, from prevention to treatment to palliation and to survivorship. So we need an adequate workforce in terms of quantity, quality and relevance.

Two of the main challenges are training enough people and training them in the right way and also employing them. Sometimes we train oncologists, we train oncology nurses but they don’t get enough jobs. So for that we need to not only talk to the Ministries of Health and other stakeholders, we have to make a paradigm shift which is we have to make a case for investment in the workforce, that the cancer workforce will not only provide better outcomes for cancer patients but they will also generate socioeconomic dividends, they will help prevent a huge loss of money that Africa is seeing, so medical tourism with our patients getting treated in India and Europe and elsewhere. Also in terms of gender perspective as the majority of the workforce in nursing are also women.

Also, based on what the WHO has recently come up with which is the main lessons from COVID-19 is we need oversupply of the workforce. We should not be talking that we need sufficient workforce, we actually need to aim for oversupply. The reason for that is if there are crises or if there are threats to the system, you need an adequate workforce and you can only achieve that through oversupply.

There is also another threat that happened after COVID-19 in Africa. Before COVID-19 we saw less of the brain drain which is people leaving the continent to work in the UK and elsewhere, it was starting to get less and less. But, because of the economic shocks that happened after COVID-19, we are seeing a return of the brain drain. So I also called during that keynote is to improve the economic conditions and the working conditions and salaries for the workforce in Africa. Also I called on high-income countries to train an adequate cancer workforce in their own country and that will lessen the pull factor. To put all of this together we need to come together as a region at the country level, at the regional level, at the continental level and also at the level of the global oncology community.

That was a brilliant overview, I think you covered everything I was going to ask.

Other aspects we concentrated on the workforce during this UC are, if you look at the programme, we looked at several aspects of workforce optimisation. For example, African oncologists are always asked to do research, see patients, do advocacy, do leadership, but we wanted to look at the home where can this happen. So one of our sessions is African oncologists’ love/hate relationship with academic institutions to try to optimise, especially for academic oncologists, what is the best way to make sure that they have thriving careers and they can do what they would like to do. We’re looking at promotion, we’re looking at the role of task shifting and, of course, we are looking at the gender aspects when we talk about the women, the Lancet Commission on Women, Power and Cancer.

What is your role in the Women, Power and Cancer: A Lancet Commission?

My role was in two main areas. One of them I was one of the group that looked at the main framework, which is the families framework. Here we looked at the power asymmetry that women experience at the level of economic power, at the level of education and at the level of access. We looked at how we can actually tackle those power asymmetries so that we can improve outcomes for women. When say women we are not only talking about women’s cancers like breast or cervix, we’re looking at all cancers including colon and the others, and lung cancer. We are also not only looking at women as patients but we are looking at women as caregivers and also we’re looking at women as part of the general population in terms of prevention.

So there were a lot of significant findings from the commission – a lot of the caregiving roles that women are doing are not compensated. Women experience more financial toxicity and also a lot of the cancers experienced by women are actually not preventable. So we need more research, including in what’s known as traditional women’s cancers like breast cancer.

Then my other role in the commission was also the part on workforce and education. So we looked at women in leadership. We found that women’s representation in leadership is less across all organisations in cancer centres. We looked at women in research; we looked at women as participants in clinical trials and leading clinical trials. Finally we looked at how do we ask ourselves the question? How do we make sure that we train the workforce, whether this workforce is composed of women or men, how do we train that workforce in order to provide competent care for women that is also respectful?

So we came up with what’s called the Gender Competencies Framework and we are calling for all professional institutions, professional bodies, to adopt and adapt that competency framework. So we looked at several domains – provision of care, making sure that women get guideline-concordant care. We looked at toxicities of therapy that uniquely affect women. We looked at issues of fertility and we looked at issues of provider-patient concordance and how that can affect women negatively. We also looked at the workplace where we need to have gender responsive policies in terms of equal pay, in terms of maternity and paternity leave, and also freedom from sexual harassment and from discrimination. We looked at especially women, the disparities that women experience, especially women patients who are working in the informal sector – when they go through their cancer journeys they are affected more economically and that may lead to delay. So we want to shift that kind of culture of blaming the patients for late presentation. We also address issues, even in global oncology, of the decolonisation of the curriculum.

In order to implement that we want this to be adopted and also be embedded in the curriculum through lifelong learning from the time they are students or residents or nursing students, all the way as they enter the workforce.