National Cancer Control Programme in Nepal: How to go about?
By:
Dr Sudip Shrestha, MD.
Executive Chairman
Nepal Cancer Hospital and Research Center.
Cancer is an increasingly important factor in the glo¬bal burden of disease in the decades to come. According to World Health Organization the estimated number of new cases each year is expected to rise from 10 million in 2000 to 15 million by 2020. Some 60% of all these new cases will occur in the less developed parts of the world like ours. Being one of the most costly modalities of treatment Are we prepared to face this burden?
Improved cancer control need a good prevention strategies and early detection programmes, including information campaigns and population-based screening programmes. Success of the early detection programmes will rely on effective and optimal use of treatment possibilities. In spite of the explosion in knowledge and development in science, it is going to take decades to win against cancer death. The aspects of cancer control must therefore be seen within the context of a systematic and com¬prehensive approach, that is, the cancer control plan or strategy.
Forces in the fight against cancer include the government sector, the non-governmental sector, the private sector and the professional organiza-tions. Their common objective is to reduce morbidity and mortality from cancer. Each sector plays an important role within a national cancer control programme, though the relative extent of that role varies depending on the situation in the country. The non-governmental sector is involved in cancer research, cancer reg¬istration, cancer prevention activities, treatment and care facilities, and programmes. The non-governmental sector is an important source of technical know-how, skills and resources relevant for cancer care and research. Furthermore, non-governmental organizations provide an important ability to reach out to the professional and public communities.
A national cancer control programme is a public health programme designed to reduce cancer incidence and mortality and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treat-ment, and palliation, making the best use of available resources. Unfortunately in Nepal we do not have any kind of National cancer control policy yet.
Key to the success of the National cancer control program is strong Political commitment along with careful planning and appropriate priorities, within the scope of preven¬tion, early detection, treatment and palliation. The establishment of national cancer control programmes offers the most rational means of achieving a substantial degree of cancer control, even where resources are severely lim¬ited . Effective and efficient cancer control programmes need competent man¬agement to identify priorities and resources and to organize and coordinate those resources to guarantee sustained progress to meet the planned objectives
Last few years Nepal has noticed significant improvement in the health parameter as far as the infectious disease is concerned. But as seen internationally the non-infectious diseases including cancer is becoming major health issues. Nepal where available resources to tackle the ever increasing loads of cancer patient is far from the basic need. Limited establishments to diagnose and treat cancer has definitely showing the need of preventive activities and at the same time judicious use of limited resources. At the same time we need to prepare for future by proper planning to develop adequate infrastructure and human resources to fight against the cancer. In Nepal for this reason establishment of a national cancer control programme is recommended at the earliest.
Although it is clear that objectives and priorities need to be tailored to the specific country context, World Health Organization has given 4 basic steps in the planning processes to develop National Cancer Control programme. : 1. assessing the magnitude of the cancer problem, 2. setting measurable control objectives, 4. evaluating possible strategies for cancer prevention and control, and 4. choosing priorities for ini¬tial cancer control activities.
The national cancer control programme policy should be formulated once the planning process has been completed. This will provide a solid platform for implementing and maintaining a national cancer control programme. Good leadership of the programme is key to its competent management. The national programme coordinator should be able to work in a team and facilitate or reinforce the building of a network of local coordinators, backed by their own teams, who will take a leadership role in their areas or regions. It is essential to build effective teams, that are results oriented and committed to the project objectives, goals and strategies, as most of the managerial, clinical or community activities in a cancer control programme require teamwork.
The motivation to initiate a national cancer control programme need strong advocacy from health care leaders. It is the right time for SAARC Federation of Oncology- Nepal (SFO-N) to take this leadership and play advocacy role for the same. The reason for SFO-to take this lead is due to following reasons: (1). It is a non political Professional body of the oncologist of Nepal. (2) Its mother organization being an only organization representing SAARC countries having similar cancer burden and issues. (3) Its members are represented from all the institutes from all over the country. (4) Its members are already having great experiences in oncology both nationally and internationally. (5) Most of members are already in the position to play vital role in advocacy. (6) The organization is already playing active role to help professionals to enhance their knowledge through seminar, lectures and conference in related fields. Now it is high time, we all need to join hands and play an important role in advocacy and help Nepal government to establish our “National cancer control programme”. It should be the challenge for future leadership of this organization.
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