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Tackling cancer in low- and middle-income countries

By Elissa Dakers | 26 Sep, 2016

According to the WHO, cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012. The burden is overwhelming in low- and middle-income countries (LMICs). The CDC reports that more than half of new cancer cases and about two-thirds of cancer deaths occur in LMICs, but only 5% of global cancer resources are spent there.

Unfortunately, cancer is rarely the top issue in global health and development discussions. Perhaps this is because policymakers find it too hard to tackle, as noted by speakers at a Royal Society of Medicine event last week. One expert painted cancer control as a Mount Everest style challenge because it depends on “a vast set of capabilities, from complex infrastructure to technological capacity to end-of-life care.”

So, faced with a mountain before you get to cancer control, where do you begin? Experts suggest some options that can be delivered easily: simple diagnostic technologies, training nonspecialists to treat common cancers, better pain management, etc. A persistent challenge, however, is the poor availability of cancer registry data in the developing world. Access to accurate data is essential to engage policymakers ("what gets measured gets done").

Please feel free to share your thoughts on how to best tackle cancer in LMICs. How do we get the ball rolling?



Elissa Dakers Replied at 4:19 PM, 26 Sep 2016

Please refer to the links below!

Attached resources:

SYLVANUS OKPE Replied at 9:49 PM, 26 Sep 2016

In order to carve a way forward in tackling the burden of cancer in resource-limited countries, we need to carefully identify the existing problems, then begin to proffer solutions. some of the challenges to cancer care in these settings could be summarized as follows:
-Late presentation due largely to ignorance
-Limited diagnostic facilities in most centres
-Limited capability to effectively monitor therapy
-Some of the drugs in a particular protocol/regimen may not be available in the country
-Poverty limits patients' ability to pay for tests and procure drugs
-Only a small percentage of people are on Health Insurance
-Supportive care is often inadequate
-Cancer care is generally capital intensive/expensive.
Suggested ways forward include:
-Doctors in the various countries should document the burden of the problem
-Advocacy to our Governments to prioritize their budgets towards upgrading resources for cancer care
-Training and re-training of staff. Observership programs in centres with state-of-the-art facilities and personnel would improve knowledge and skills that can be adapted to care in resource-limited settings. (I just benefited from such at the Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio through the Nurturing Children's Development Program of Procter & Gamble in collaboration with the Paediatrics Association of Nigeria and the Global Health Center).
-Linkage with the Children's Oncology Group.
-NGO involvement: Can we not have the kind of money committed to HIV/AIDs, TB and Malaria control over the years to the control of Non-Communicable Diseases?
-A lot of sustained public enlightenment campaign is required to change people's orientation and beliefs about cancer.
-If Health Insurance is made Universal, it will go a long way in aiding the poor and indigent to receive appropriate therapy.
We as advocates must not rest on our oars in persuading our Governments and law makers to give an ear to cancer-related matters in their yearly budget provisions. This we can do through our medical associations.
Dr Okpe, Edache Sylvanus.

Claudia Lefko Replied at 12:42 PM, 5 Oct 2016

The conversation around cancer is interesting, and in my mind is very much connected to a simultaneous discussion on the nursing/midwifery thread concerning "help" and types of interventions in the world of global medicine. I remind readers my background is not in medicine but education/humanities; nonetheless my "work" for the last 15 years has been to partner with two Iraqi pediatric oncologist on a pediatric oncology unit in Baghdad. It is one of the largest cancer facilities--by the number of patients served-- in the Middle East

According to their records, the rate of cancer cases has nearly doubled on this unit an over the last two decades; we cannot comment on the situation overall as there is very little reliable information available in a country that has been so damaged by war, economic sanctions and post-war violence and corruption. Despite the problems, the senior doctors on the unit have both reached out and been open to international offers of help. This has enabled them to maintains some standard of care and in some cases, as a result of collaborations, they have improved care for certain cancers.

Cancer is a present and expanding problem in Iraq; asking "where do you begin when faced with a mountain" seems to ignore the reality that doctors in Baghdad and around the world are already working to care for cancer patients in whatever way, with whatever resources are available to them. They have already begun, and it seems it might be our "job" as people in the first/developed world to try to bring them and their stories to the forefront of discussion on this issue. GHDonline s doing that to some extent, although as you see…the Baghdad doctors/nurses are not writing, I am writing here. As their partner/advocate I have the time and resources to follow this discussion and reflect on what is being said.

All of the challenges Sylvanus points out exist in Baghdad, although the hospital is a public one, and so care at this facility is offered without charge. In terms of the suggested ways forward, we have found many not workable. In particular, the education, training and day-to-day experience of a doctor/nurse in Baghdad is so very different than that of medical personnel in the first/developed world that it is difficult and maybe impossible to take advantage of international training opportunities that are not specifically geared to the level of the participant from a particular LMIC. And, it is nearly impossible for various reasons to bring international health workers to Baghdad. One avenue of "help" not mentioned which is very valuable, in my opinion, is for global health workers--especially in response to locations deemed off-limits because of security reasons-- for health workers to become vocal advocates, working in collaboration and on behalf of doctors/nurses/hospitals/clinics in LMICs. We can be of help from "afar", and are not always needed on-site, although on-site is obviously extremely helpful when it is possible.

What is working for us in Baghdad right now is to focus on developing projects/ programs to improve capacity and care from the inside out. In July we launched IPONET (Iraqi Pediatric Nursing Education and Training) at a meeting in Amman. Six nurses and five oncologists from the Baghdad unit spent some days outlining the existing problems and challenges, and creating a plan of action; we are now working to find funding to implement this grassroots effort.

Finally I will quote from Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries, A Report of the Global Task Force on Expanded Access to Cancer Care and Control (2011 President and Fellows of Harvard College acting through the Harvard Global Equity Initiative) because it reminds us that "…capacity-building around cancer can strengthen health systems overall."

"Further, cancer advocacy can reinforce the global health and NCD agenda. …Cancer is in fact a'communicable' NCD-it is one of the diseases for which effective communication can catalyze a global movement. Advocacy and activism around cancer, if positioned with an agenda for health system strengthening, can provide a human face to NCDs and convert cancer and other chronic illness into a priority for global and national health agendas." (pg. 6)

Thanks for opening this discussion. I hope to see it continue and expand. We are looking for others in our situation, to share experiences, ideas, strategies and even curriculum for training and education.

Tinashe Goronga Replied at 3:28 PM, 6 Oct 2016

A lot of factors attribute the burden of cancer in developing countries.
Lack of information
Over the past few years there has been a lot of emphasis on communicable diseases which greatly affected life expectancy. We have made some progress resulting in life expectancy improving and now people are noticing the impact of ncds including cancer. Most of the health promotion products and funded programs were neglecting cancer and noncomunicables. You then find a significant population not aware of what cancer is or the risk factors etc because it’s been viewed as rich country’s disease. It would be great to ride on the HIV/AIDS programs to address and raise awareness about cancer and non communicables
Lack of diagnostic services
In my country specialists investigations like CT Scans, endoscopies are done at central hospitals in big cities . Their costs is unaffordable to the majority which forms a barrier in seeking and accessing healthcare. A person might come early and a clinical suspicion is made but however they may not afford investigations for definitive diagnosis. There is therefore need to come up with guidelines with limited resources in mind. Private public partnerships have helped a lot. For example there is an organisation called Kidzscan which funds paediatric oncology patients in accessing investigations and treatment and has contributed to improved outcomes.
Some of the health systems are depended on donor funding influencing priority areas depending on availability of funds. Most of the money has also been invested in communicable diseases. There is need to look into patents for cancer drugs and classify them as essential drugs and maybe also promote generics to increase availability and promote affordability.

Social construction
Every society has its own theories about what disease is and how it can be treated or prevented. As the educated elite we at times fail to realise our privilege and assume everyone is ignorant and end up promoting programs which are not culturally sensitive or relevant to a particular society resulting in a failure rate. We need to rethink models of intervention and promote participatory action research. Traditional and faith healers are at times the first point of contact and can be a factor contributing to late presentation hence the need to rope them in and encourage them to refer their patients to formal healthcare systems. Ignoring cultural and religious beliefs of a community may result in rejection of a well-meaning program. Health professionals need to be aware of social determinants of health and factors contributing to unequal access to health and differences in outcomes. Health professional training should therefore be modified to factor in the local context connecting it with the bigger global picture as opposed to following outdated colonial curriculums. There is also need for laying a strong foundation targeting future generation through integration of health education in primary and secondary school curriculums.
Increasing budget allocation for health
This will go a long way in promoting growth in the sector . However there is now need for an integrated approach to tackling disease as opposed to compartmentalization community health workers are the foot soldiers. They are in contact with the majority of people with no health facility within proximity and who rarely have access to doctors .They need to be equipped with knowledge on Non communicable diseases and primary health care facilities should expand their scope of focus. National health insurance such as in Rwanda and other funding models are needed for sustainable programs. Political will is also important . There is also need to channel resources to cancer research and registry .
Restructuring of health systems
The health systems need restructuring and need to embrace technology especially the low cost high impact technologies. Referral systems need to be strengthened to improve flow of patients , resources and data. Management should start at primary care level because these facilities are accessible to the majority

Lucas Maganga Replied at 11:20 AM, 7 Oct 2016


Tayreez Mushani Replied at 6:51 AM, 8 Oct 2016

Hello All,

Thanks Claudia, sharing your work in Iraq.

In Kenya, we have developed the first Diploma in Oncology Nursing curriculum and started classes in August in Nairobi and in September in Eldoret (a small city in western Kenya). We developed the curriculum based on the standards of the Canadian Association of Nurses in Oncology (CANO). Ours is a triparty partnership - between the Princess Margaret Cancer Centre in Toronto, Canada, between a private non-profit university in Kenya (Aga Khan University) and a public hospital training school (Moi Training and Referral Hospital) in Eldoret. We are very encouraged by the support of our partners both overseas and locally.

We hope to expand this program into the East African countries to build cancer nursing capacity and to promote research that is relevant to the region. At present, as we attempt to contextualize the program, we are challenged by the lack of local research to help guide nursing interventions.

Claudia, as in Iraq, cancer in Kenya is also a present and expanding problem. As we empower nurses with specialized knowledge and skills, we can hope to slowly make gains in improving care for cancer patients in the region.

Patricia Brock Howard Replied at 10:42 AM, 8 Oct 2016

See below for opportunity

Jostas Mwebembezi Replied at 4:29 PM, 8 Oct 2016

Thank you all for the exciting content

Tayreez, Am glad that you plan to extend to other countries, do you have Uganda as part of your extension plan?

Thank you.

Jostas Mwebembezi (Statistician)
Founder and Executive Director || Rwenzori Center for Research and Advocacy (RCRA)
Consultant || Manchester Global Foundation ||
Director of Education || Enabling Support Foundation ||
Facilitator || USAID Learning Lab/RCRA-OVC-WG || Skype: Justus325 || Twitter:@JostasM || P.O.Box 898,Fort-Portal, Uganda, East Africa || ||
Tel:+256(0)786-207-767 || Office: +256(0)483-660417 || Mob:+256(0)774-553-595
This message and its contents are confidential and solely for the intended recipients. If received in error, please delete them and notify the sender via reply e-mail immediately.

Claudia Lefko Replied at 5:33 PM, 8 Oct 2016

Patricia, is there an attachment I am missing from your message? And also to Lucas's message, FYI. I am not seeing anything on my email.

Sandeep Saluja Replied at 9:28 PM, 8 Oct 2016

In this context,please permit me to say that there is an imperative need to
develop treatment protocols best suited for such circumstances.It is not as
simple as just omiting the expensive drugs.In fact the cost of therapy is
very different from the cost of drugs.A seemingly more expensive drug may
be cheaper if it is easier and more economical to monitor and manage its
adverse effects.It is also not as straight forward as just adopting the
older regimens.
We need to have a total re look and conduct trials specifically in such

Syed Mahbubul Alam Replied at 7:00 AM, 9 Oct 2016

Dear All,
As we know that Cancer treatment is expensive and also endless suffering for the patient. We need to focus on prevention. Prevention initiative will reduce the burden of health cost. Unfortunately around the world, LMIC govt. has focused on treatment.

We need to focus on hitting root causes of cancer by enact law and policy and implementation. In the LMIC countries, cancer is increasing due to the use, environment pollution, unsafe safe food etc.

Syed Mahbubul Alam, LL.M
Advocate & Policy Analyst
Dhaka, Bangladesh

Claudia Lefko Replied at 2:55 PM, 9 Oct 2016

Dear Syed. I agree with you, but alas, as in the case of Baghdad, there is enormous environmental degradation--some of which may be the cause of the increase in pediatric cancers. Of course, a two-prong strategy is needed: prevention but also treatment and care.

I am no expert, but it seems the causes of many cancers--not just in Iraq, but in locations around the globe-- may be or have been proven to be the presence of substances/environmental conditions beyond the control of local or even national governments. Advocating/legislating against this contamination, arguing for more protection and prevention is one avenue for those working on cancer, dealing with the healing and care is another.

Syed Mahbubul Alam Replied at 10:54 AM, 10 Oct 2016

Dear Claudia
We need to focus on controlling over the gateway of cause cancer. If we ignore prevention and focus on treatment issues burden of health cost and people suffering will be increased, once it will out of control.

I know it a hard job. but our coordinate work, make it easy. We need to keep pressure to the policy makers and has to create public support. Tobacco Control one of the best example around the world.

As a health advocate, if you want to reduce people suffering and burden, we have to focus on prevention. And formulation of policy should be first initiative.

​Syed Mahbubul Alam, LL.M
Advocate & Policy Analyst

Flat-F2, House-38 Road-104,
Gulshan, Dhaka, Bangladesh
Mobile: 8801550600206 Phone: 88088810004
E: , Skype:tahinbd
FB:smatahin, Twitter: SMAlamTahin, in:syedmahbubulalam

King-Tung Chin Replied at 11:27 PM, 10 Oct 2016

Prevention is important but unfortunately genetics still accounts for a high proportion of causes for cancer. I think rich nations should help out LMICs to strengthen their cancer epidemiology studies so that the vital resources can be allocated to deal with the crucial factors contributing to cancer incidence locally.

Vivian Huang, MD, MPH Replied at 9:13 PM, 11 Oct 2016

Liver cancer can be prevented by ensuring that individuals living in hepatitis B prevalent areas get adequately vaccinated. We have 2 very effective anti-cancer vaccines, HPV and HBV. We can start by ensuring that all infants born in intermediate and high hepatitis B prevalent areas get vaccinated at birth and continue w/ the series.

Jing Wang Replied at 10:34 PM, 24 Oct 2016

Thank you Elissa for your posting. Cancer control is a complex and heavy topic which is related to almost everyone in the globe, from individuals living with cancer, whether young or old, their families, friends, colleagues, caregivers, health care providers, researchers, governmental officials, and so forth. And it is so true that cancer control requires “a vast set of capabilities, from complex infrastructure to technological capacity to end-of-life care.” I also strongly agree with Tinashe that we cannot simply copy and implement programs or strategies from others countries. A culturally-sensitive strategy or program need to be developed based on the understanding of local culture and interpretation of evidence from accurate cancer data in this region or country.
In addition to infrastructure and technological capacity, availability and acceptance of palliative care for individuals with cancer is another barrier to improving their well-being in LMICs. Health disparities and inequality also pose severe challenge to cancer control in developing countries.
I would like to share with you an article entitled "'Cancer hotels' house China's patient refugees" by Reuters
"In the shadow of one of China's top cancer hospitals in Beijing, a catacomb-like network of ramshackle brick buildings has become a home-from-home for hundreds of cancer patients and their families waiting for treatment." They are called as "cancer refugees". They travelled hundreds of miles to city hospitals because of lack of cancer control and treatment facility and resources in their home cities. To them, diagnosis of cancer means poverty, low quality of life for both patients and their caregivers and struggling.
After years of health care reform, China is in still in a difficult stage with tremendous challenges from its health care system.

How to tackle cancer in LMICs is a mountain to climb.

Natsuki Shimegi Replied at 2:14 AM, 2 Nov 2016

Thank you for posting Elissa. It seems reasonable that this topic invite many discussion. In my opinion, it is not avoidable that tackling with cancer in developing countries comes behind other diseases, though it is unfortunate for patients of them.

As above discussed, the costs and period are huge to burden to treat it. Even in Japan, some people bankrupt when they fight against cancer. People do not know how long does it take to cure. People do not know even whether cancer can be eliminated. People do not know when it occur again in the future after the surgery. Patients and family have to face not only cancer but also uncertainty of the future of family if once they decide to cure the cancer.

Therefore, it will be higher burden for people in developing countries to cure the cancer. Before fighting with cancer, I think the insurance and other health system which enable family to concentrate on treating cancer have to be established. Otherwise, people will suffer from lack of funds to treat cancer.

Katherine Pettus Replied at 6:50 AM, 2 Nov 2016

This is why it is so important to integrate palliative care into any
strategy to tackle cancer in low resource (and all!) countries. Unless
palliative care is integrated into health systems and providers are trained
in honest communication, patients and families are tempted to try futile
"cures" that lead them into catastrophic out of pocket expenses and extreme
poverty. Universal coverage is also key, but at the very least health
systems must prioritise palliative care and access to medicines in
countries where diagnosis often comes to late.

Dr. Katherine Irene Pettus, PhD
Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs <>
Secretary NGO Committee on Ageing, Geneva

Skype: katherine.pettus

*"Each morning we must hold out the chalice of our being to receive, to
carry, and give back."*

Jing Wang Replied at 8:55 PM, 5 Nov 2016

I agree that it is crucial to integrate palliative care into cancer treatment and care. I do believe that honest and effective communication is an important part of it. We know that patients and their families should consent the medication and their treatment plans but how physicians communicate with them do affect their decisions greatly. If a physician mention about a new medicine on trial to patients and their families, they are very likely to be tempted to try it. People don't like doctors who tell them that there is not much that we can do, they love doctors who tell them that how to cure it. To me, I believe that palliative care requires more resources and workforce preparations, which can be a challenge for developing countries with limited resources. It seems like health care providers are doing less in palliative care but actually they are really doing more. Taking pain control for example, a great number of patients with cancer in developing countries do not even have adequate access to opioid analgesics, let alone a holistic pain management service. But I do believe changing perspectives are the first step to integrate palliative care into cancer care.

Epie Njume Replied at 12:07 PM, 6 Nov 2016

I agree with Wang, we need a change in perspectives. We also need studies on the determinants of quality life of cancer patients to help us tailor our limited resources to meet theirr needs.

Tayreez Mushani Replied at 6:23 AM, 7 Nov 2016

Hi Jostas,

We certainly have Uganda as a target place where we would like to implement our Oncology Nursing Diploma program. We will do this at our sister campus of the Aga Khan University School of Nursing and Midwifery.

Hope this helps.

Please contact me if you have further questions: <mailto:>

Tayreez Mushani Replied at 6:27 AM, 7 Nov 2016


You make an important point. Patients and families often spend their life savings on treatments that do not necessarily provide significant increases in lifespan or quality of life. It is vital that these patients and families are given the correct information at the start of treatment. A serious illness like cancer can be a serious financial burden for some families.

Elissa Dakers Replied at 1:41 PM, 7 Nov 2016

Thank you for contributing to this discussion! As you may be aware, GHDonline is currently hosting an Expert Panel on opioids. I encourage you to join a discussion thread on access to opioids for pain treatment and palliative care in LMIC, linked below.

I look forward to continuing this discussion!

Attached resource:

Jim Cleary Replied at 1:52 PM, 7 Nov 2016

Thank you.
Unfortunately, few of the questions/discussions in Access to Opioids relate to LMIC..
Not that much a global health discussion.



Blen Biru Replied at 3:57 PM, 8 Nov 2016

In my point of view, the very first step to tackle cancer in LMICs would be strengthening the cancer registry data. If there is reliable data, public health professionals would be able to come up with evidence based solutions, whether it is allocating available resources or engaging with policy makers. As discussed in this thread, we can not simply apply policies that worked for other countries, rather policies need to be carefully tailored to the specific country’s need. This is to say that we can only come up with a culturally-competent policy if we have accurate history and diagnosis of patients that reside in the country. We can then determine what actually causes cancer and what age group/gender is most likely to get diagnosed with cancer in a specific country. Such kind of information obtained from cancer registry will be very instrumental in tackling the disease in LMICs.

With that being said, I also think that global partnerships play an important role in tackling cancer in LMICS. For instance, as discussed in this thread, the establishment of the first Diploma in Oncology Nursing curriculum in Kenya in collaboration with the Canadian Association of Nurses in Oncology with the aim of expanding to other East African countries is a great start. Global partnerships will help a country’s advancement in research and increase awareness of latest cancer treatment and diagnostic technologies.

Lovemore Gwanzura Replied at 10:02 AM, 21 Nov 2016

HI all !
> How can we can funding to strengthen cancer epidemiology studies in poor countries? When it comes to Infectious diseases there are many funding opportunities available. I am certain that there is a need for paradigm shift world wide for poor countries to be able to assemble enough epidemiological data of NCDs such liver cancer etc so that the little resources available in their country and the expected larger recourses from donors can be allocated to deal with crucial factors contributing to cancer incidences currently observed.
Lovemore Gwanzura Bsc. Mphil. Mmedclinepi. PHD. ZAS fellow
Professor CHSC,University of Zimbabwe
Lab Director BRTI

> On Oct 12, 2016, at 3:19 AM, Vivian Huang, MD, MPH via GHDonline <> wrote:
> -

Chu VANG Replied at 8:08 PM, 21 Nov 2016

Dear Lovemore

I am not expert in the field however I know that there are recommendations available on WHO GCMNCD working group2's final report on how to get funding for NCD including Cancer. The file is attached below.

Prof. Vang Chu

Attached resource:

King-Tung Chin Replied at 12:02 AM, 22 Nov 2016

Dear Elissa and Blen:
I agree that strengthening cancer registries in LMICs is very crucial. However developing a comprehensive and meaningful cancer registries may prove to be a daunting task even for experienced pathologists in the field. The scare availability of cancer samples in LMICs (due to lack of basic healthcare resources) and the nature of the molecular heterogeneity of those samples may add another layer of difficulty and complexity for healthcare professionals in these nations. Coordinated and logical central policy deployment which maximise the utility of allocated resources seem to be of a much higher priority. Therefore I suggest expertise in rich nations should help LMICs to access their current stage of healthcare development and provide suggestions to develop a meaningful and sustainable healthcare plan for individual LMICs.

Jemal Ibrahim Replied at 2:27 AM, 22 Nov 2016

Hallo dear brothers and sisters. This is Jemal Alemu from Ethiopia. this topic is very important in developing and low income countries. In my country the prevalence as well as distribution of cancer(both solid organ and blood) is not documented well even-though reports from few hospitals indicated that the burden is very high. I think the following reasons have contributions
=>Shortage of professionals(hematologists and pathologists...)
=>shortage of facilities and lack of advanced laboratory diagnostic techniques for the disease
=>The government gives priority for infectious diseases
=>Shortage of fund to conduct researches in the area
=>Lack of attention by the Medias to aware the society
=>limited health facilities to screen the disease

Anna E. Schmaus Replied at 7:48 AM, 22 Nov 2016

It is mentioned in the first reply "Limited diagnostic facilities in most centers".
We developed a Telediagnostics platform which allows to upload histopathology, cytology, radiology pictures and documents into a patient case. We provide expert doctors who will write diagnoses. This will not solve all problems connected to cancer, but it helps those doctors in LMICs to get a 2nd opinion.

We provide this web-based platform as a company. We have to pay our software developers therefore we have to get money (license) for the use of the platform. Some of our expert doctors write the diagnoses for free, others want to be paid.

We developed a mixed license scheme.
We start from "free" for certain hospitals in lower income countries which can prove their needs
Then we charge some money from hospitals in lower income countries.
We charge a bit more from hospitals from middle income countries.
The highest license fee we charge from hospitals in high income countries.

We think that is fair and will hopefully help as many patients as possible.

You can get into contact with me, I am the owner of the company.
Anna E. Schmaus-Klughammer
Klughammer GmbH

Have a look at the NGO "One World Medical Network"
This NGO does training (blended learning, eLearning) for doctors, midwives, nurses and medical personnel.
We train histopathologist and cytologist.
We also do training to learn how to read ultrasound pictures and get a better diagnose. We concentrate here at pregnant women and breast cancer screening.

Lilian Chumba Replied at 9:44 AM, 25 Nov 2016

Hi everyone,
Thank you all for participating in this discussions and for the great inputs. I believe that all these difference approaches are equally important. They are all looking at the elephant from different angles. I believe that it's not really about where to begin. We need to begin everywhere. We cannot say that we will do one thing first then once that is done go to the next one. Tackling this mountain is a collective effort, from the local communities to international partners, from community health workers to specialized oncologists, from traditional healers to contemporary healthcare workers, from me to you. We need to increase awareness of cancer and other non-communicable by incorporating health and disease in our education curriculum and vigorous public awareness campaigns. We need to improve hospital records and registries. We need to strengthen our healthcare systems to better tackle chronic diseases. We need to train and retrain more healthcare workers to take care of chronic diseases. We need to change policies and increase funding for non-communicable diseases. We need to create a movement, perhaps we need to start by changing this "non-communicable" name to "chronic communicable" diseases to make the world realize that these diseases affect everyone, stay longer and have worse outcomes in the long run and so we need to pay more attention to them and deal with them before they become a global health emergency. This has been done before with HIV, it can be done again with "non-communicable diseases" Lets keep the fire burning.

Tinashe Goronga Replied at 12:05 AM, 27 Nov 2016

Hi everyone . What do you think about devising a primary health care
Structure integrating NCDs including cancer at that level. Most people in Low Income Countries have primary health care facilities ie clinics as their first point of call and are more easily accessible than hospitals. I applaud the project in Kenya to train oncology nurses I can imagine having such trained personnel at primary healthcare facilities screening people and recommending them for further investigation and management and having supporting telemedicine infrastructure for collection of data and to aide in diagnosis like the example given by Anna Schmaus. Then develop community based palliative care . Task shifting will be helpful

Simon Onsongo Replied at 3:37 AM, 29 Nov 2016

cancer is a big problem that kills many people in the developing. The infrastructure to tackle cancer is weak, starting from lack of adequate trained and skilled manpower to either make the diagnosis and treat cancer, lack of adequate support in cancer care. The public health information on cancer is also quite limited which means most cancer cases are diagnosed late or sometimes never picked. All the stakeholders including the governments and other partners must have a multi-targeted strategy address the various cancer challenges in the developing world. Time the affected governments stopped dreaming and faced the reality and the burden of cancer since it can only get worse!

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