Due to government delays to strike a deal for cancer treatment with Tanzania, many Zambian cancer patients are compelled to seek specialised medical care in India. This predicament arises from the constraints faced by the country's lone cancer hospital, burdened with outdated and obsolete equipment.
Additionally, the situation is worsened by the shortage of human resources for cancer care at all levels. According to the National Cancer Control Strategic Plan (NCCSP) for 2022-2026, the country currently has only 88 medical personnel, significantly below the recommended 3,130.
Furthermore, the NCCSP for 2022-2026, reveals that the government currently assigns less than 1% of the annual healthcare budget to cancer services, significantly below the targeted 5%.
This financial limitation exposes patients to the risks of delayed presentation and treatment abandonment.
The Cancer Diseases Hospital (CDH) disclosed that any patient in need of radiotherapy treatment is referred to India. However, this decision hinges on various factors, including the availability of resources and treatment options, as well as the capacity of Indian hospitals, which already cater to other patients.
According to the cancer hospital, from 2023 until now, 40 patients have been sent to India, with an additional 20 soon to follow.
Cancer patient’s testimony
Consider the case of a 69-year-oldman, referred to as Mailoni Phiri to respect his anonymity request. It took the hospital over four years to diagnose his cancer.
Phiri's health started declining in 2014, initially unaware of the underlying issue.
He experienced difficulties with frequent urination.
"I began experiencing difficulties with urination; I would frequently feel the urge to urinate, but when I attempted to do so, I couldn't," Phiri recounted.
Initially seeking medical assistance at Kabwe Central Hospital, Phiri found no solution to his ailment.
The hospital prescribed some medications that provided temporary relief from his pain.
Phiri's ordeal persisted for a prolonged period until he eventually sought help at the University Teaching Hospital (UTH) in 2017.
"I continued to face this challenge until 2017 when I decided to seek treatment at the University Teaching Hospital. They examined me and provided medication, but they did not confirm that it was cancer," he recalled.
On November 11, 2020, Phiri returned to UTH, where samples were collected from him.
However, it wasn't until March 2021 that Phiri received his test results, revealing that he was diagnosed with prostate cancer.
Tragically, by the time his cancer was detected, it had progressed too far for effective treatment options.
He was informed that the only potential recourse would be surgery, as the cost of medication was deemed prohibitive at that stage of the illness.
In 2022, his condition worsened, prompting him to return to UTH, only to be informed once again that they couldn't provide assistance unless he underwent surgery. Unable to afford the costly medication, he felt hopeless and returned home without help.
In 2023, Phiri sought help again, pleading for any assistance available. It was then he was asked if he was a member of the National Health Insurance Management Authority (NHIMA) Scheme. Being a member, NHIMA confirmed his eligibility for treatment, and he began medication.
Current situation
Zambia has only one hospital providing comprehensive cancer care for its population of 19.6 million people. This hospital, located on the grounds of UTH in the capital city of Lusaka, was opened in July 2006 and inaugurated on 17th July 2007.
Prior to the construction of the hospital, the government sent cancer patients abroad at a cost of US$10,000 per patient. This expense has likely increased since then.
Due to limited budget allocations for treatment abroad, only 350 cases out of 5,000 were sent between 1995 and 2004.
Had the Tanzanian deal been successful, it could have significantly reduced the cost per patient, covered by the government.
In November of last year, the government announced that cancer patients in need of radiotherapy would be referred to Tanzania for treatment as the Cancer Diseases Hospital undergoes machine replacements.
Presently, with much of the essential equipment for cancer diagnosis and treatment at the hospital being obsolete and non-functional, the country finds itself reverting to its pre-2006 state, when the hospital was first opened.
In January last year, Dr. Kennedy Lishimpi, the Senior Medical Superintendent at the cancer hospital, told a local radio station – Christian Voice – that most of the radiotherapy equipment installed in 2006 remains unchanged to this day.
He underscored the hospital's limitations in effectively treating the wide range of cancers diagnosed in Zambia. He said of the approximately 13,800 people who are diagnosed with various types of cancers in the country each year, only 3,000individuals can access the cancer hospital in Lusaka.
Dr. Lishimpi highlighted that presently, only one cobalt machine, one brachytherapy machine, and one linear machine remain operational, albeit outdated.
He further elaborated that there is an existing equipment replacement plan in place, with funds already disbursed, aimed at renewing all the equipment within the hospital.
The NCCSP for 2022-2026 shows that the last significant nationwide investment in medical equipment occurred in 2007 under the ORET project.
ORET, a collaborative effort between the Ministry of Health and Royal Philips Electronics, aimed to enhance healthcare infrastructure.
On June 15, 2010, Royal Philips entered into a five-year multi-million Euro contract with the Ministry of Health in Zambia, focusing on upgrading and maintaining equipment in 71 government hospitals across the country.
Presently, much of the medical equipment experiences frequent breakdowns, with a significant portion rendered non-functional or obsolete and requiring decommissioning.
This challenge has been further compounded by the absence of maintenance contracts for equipment at the cancer hospital.
However, there is positive news as the government has secured over US$30.8 million for the rehabilitation and re-equipping of the Cancer Diseases Hospital.
Speaking during the contract signing between the Ministry of Health and Siemens Healthineers in March this year, Health Minister Sylvia Masebo stated that the project will involve removing dilapidated equipment, repairing and rehabilitating the existing building, and installing new equipment.
Response from the Cancer Diseases Hospital
Chanda Simpundu, the Public Relations Officer of the Cancer Diseases Hospital, told MakanDay that patients requiring radiotherapy may be referred to India, subject to recommendation by an Ad-hoc Committee specifically established for this purpose.
However, she said, the decision to recommend a patient for treatment abroad depends on various factors, including the availability of resources, treatment options, and space in India, which already serves other patients.
The members of the ad-hoc Committee responsible for selecting patients for treatment abroad include oncologists from the Cancer Diseases Hospital, UTH Adult Hospital, and other hospitals.
Cancer medicine profile
Cancer treatment usually involves different methods including surgery, chemotherapy, radiation therapy, and palliative care.
The current national essential drugs list does not include all WHO-recommended essential medicines for cancer management.
Supply chain management and procurement of cancer drugs and medical supplies remain ineffective, with delays in procurement and supply leading to disruptions in patient care.
The Zambia Medicines and Medical Supplies Agency (ZAMMSA) has the mandate to provide reliable, effective, efficient, and sustainable pharmaceutical and medical supply chain services for healthcare delivery.
Essential medicines and medical supplies are funded through the Ministry of Health budget and procured by ZAMMSA, as well as through pooled procurements supported by cooperating partners.
Bradley Chingobe, Senior Corporate Communications Manager at ZAMMSA, informed MakanDay that the agency recognises the urgent need for cancer drugs faced by the cancer hospital.
Moreover, he highlighted that cancer drugs are often scarce, posing challenges for individual patients to access them directly.
For Phiri, the cancer patient, he was referred to the cancer hospital, where he received Zoladex, an injectable drug used to alleviate symptoms for prostate cancer patients. Although not a cure, Zoladex has significantly improved Phiri's quality of life, relieving him of pain.
Each dosage of Zoladex costs approximately 1,300 to 3,900 ZMW ($50 to $150 US Dollars) in Zambia. Phiri started the treatment in July and will continue receiving injections every three months until 2025.
Ennety, an investigative journalist based in Kabwe, is an integral member of the MakanDay network. She is being hosted as an intern by MakanDay after earning the third-place distinction in the 2023 MaknDay Awards for Investigative Journalism.
