Supporting the development of cancer services in Zambia

In Zambia, NCDs account for 23% of total deaths. In spite of the evidence that the disease burden in countries like Zambia is changing, NCDs like cancer are still not part of the mainstream international development narrative. As a result, the global financial resources available for preventing deaths from diseases like cancer, are limited. Zambian women are facing one of the highest incidences of cervical cancer in the world and breast cancer incidence, which constitutes the leading cause of cancer mortality, is growing. In 2020, the incidence rate for cervical cancer stood at 65.5 per 100,000 women, the third highest incidence globally and a mortality rate of 43.4 per 100,000 women (Globocan 2020). Breast cancer is the 4^th most common cancer in Zambia with an incidence rate of 20 per 100, 000 women, and a mortality rate of 9.5 per 100, 000.

Although the Zambian government has shown leadership for the African continent in developing a national cancer control programme, there are many challenges.  King’s Global Health Partnerships recently joined Zambian colleagues in a workshop to finalise a second National Cancer Control Plan, which will build on the gains to date.  Cervical cancer screening has been rolled out to all districts in Zambia, and 278 cervical cancer screening clinics now have the capacity for immediate treatment of premalignant lesions.  

This is a major achievement. However, the burden on services at Cancer Diseases Hospital (CDH) in Lusaka – the only centre offering specialist cancer care – continues to grow, as the number of women  needing confirmatory cancer diagnosis and prompt treatment, increases. For most Zambian women, the cost of the journey to Lusaka and the expense of accommodation in the capital, as well as the need to leave behind their livelihoods and families, make treatment at CDH a daunting prospect. CDH is striving to provide high quality care but is overloaded and is also struggling with vital equipment failures – at present they are unable to offer radiotherapy services, so essential to the effective treatment of cancer.

The current situation also means that women in the North and West of the country often move through multiple levels of the health system before they are finally referred to CDH. This can result in significant delays between presentation, diagnosis, and treatment. It is well-evidenced that delays worsen cancer outcomes. All too often, by the time women reach Lusaka, their cancer is at an advanced stage and with no opportunity for cure.

The recent National Health Strategic Plan’s vision is the achievement of universal health coverage through decentralisation. This is good news for Zambia’s 18.4 million citizens, the majority of whom live outside of urban areas and face challenges accessing specialist care. For cancer, the government is seeking external support to establish comprehensive cancer centres in both Ndola and Livingstone. With generous support from Sanofi, King’s Global Health Partnerships is privileged to be collaborating with the King’s Institute of Cancer Policy and Zambian colleagues to undertake an assessment of current services over the next six months, with a view to identifying practical steps to support the decentralisation of cancer services. We are hoping that this assessment will support the government and health professionals as they scale up services – and will ultimately benefit cancer patients.