By Fiona Tinarwo
In May this year, I had an opportunity to be part of a team that facilitated a mobile outreach clinic in Chimanimani in partnership with Mutambara Mission Hospital. One of the most important service on offer was cervical cancer screening. I met a number of women from the community and had a chance to speak to them about the importance of cervical cancer screening. One lady honestly spoke about life after getting screened and being diagnosed with cervical cancer. She literally spoke about how that could be a “death sentence” on its own just knowing and being diagnosed with cancer. From her sentiments, it seemed quite obvious that it was much better for her to die without knowing her condition than experiencing the shock of being told that she had cancer. Quoting from her exact words “HIV testing is better as there are ARVs available for free but there is nothing for free when I am diagnosed with cervical cancer.” This is just one example and statement that represents what goes on in the minds of millions of women when they go for cancer screening.
This conversation got me thinking about how we sensitize women trying to create demand for services and even go a step further to run mobile outreach clinics for free screening of cancers of the reproductive system and yet have no further support to offer when one is diagnosed with cancer during routine screening exercises.
The world over, October has been set aside as the breast cancer month. During this month, organisations raise awareness on breast cancer and other cancers of the reproductive system. Other organisations offer free screening for cancer. The emphasis during this month is on early diagnosis. However, women who are found to have developed cancer and need further management are stuck as there is no support in the form of free treatment being provided afterwards. This is particularly the case for Zimbabwe where the health delivery system is not prepared to offer free and comprehensive support to women diagnosed with cancers of the reproductive system. In Zimbabwe, cervical cancer is the most common cancer (33.9%) followed by breast cancer (9.7%) among women, with the majority of patients (80%) presenting very late[1].
In low-to-middle income countries, the morbidity and mortality rates of cervical cancer are high owing to late presentation of cases and failure to complete treatments due to lack of resources. Challenges of affordability, availability of drugs and accessibility of treating facilities impede engagement of patients into treatment and care[2] and [3].
A 2018 unpublished study by Women’s Action Group revealed that it costs an average of plus or minus US$2,335 to access cervical cancer treatment in Zimbabwe which is beyond the reach of many women living in poverty.
Moreso, the centralized service delivery to tertiary hospitals means the costs is even higher for a woman to travel long distances to access treatment. In the case of Chimanimani, women had to walk several kilometers just to access a mobile clinic for free cervical cancer screening. Without mobile facilities, women have to travel to a District or Mission Hospital for screening which at times never happens due to transport costs. The burden becomes much higher when it comes to accessing treatment.
Some of the women we met during the study said, “I went for six cycles of chemotherapy and it was expensive for me as the procedures such as scan, blood test, medications and intravenous fluids require a lot of money. I have sold all my cattle in the rural areas in order to access treatment”.
Another woman said “My family has sacrificed a lot to the get the scan done, chemotherapy medication, intravenuos fluids and blood tests. I have just been told that my blood is not fit for chemotherapy today so I have to buy an injection to boost my immunity which costs almost US$40. I am going back home now because I cannot afford it and my children have already stretched their pockets and can no longer afford the treatment.”
Whilst we encourage routine screening for early diagnosis, it is important to think about how we can prepare women to plan for access to healthcare and further management after diagnosis through affordable health insurance cover that is linked to sound health policies that address health system challenges.
Having a clear referral system to access financial, mental and psychological support through various organisations is an important component for comprehensive healthcare.
Whilst there is limited confidence in the healthcare system, it is important to continue emphasizing the importance of early testing and early detection as a cost cutting and life-saving measure that can encourage more women to get screened.
As we approach the 2023-2024 budget cycle, I urge the Government to put in place sustainable models to finance the Ministry of Health and Child Care so they are more equipped to support free screening and treatment and ensure services are accessible to all women – this means decentralizing services so that women can access treatment. Government needs to take the central role in mobilizing requisite domestic resources.
Government should roll out more cancer screening and treatment mobile services in hard-to-reach areas so that women in marginalised communities access services. There is need for a coordinated approach for national screening programmes for cancers of the reproductive system.
[1] The National Cancer Prevention and Control Strategy for Zimbabwe, 2013-2017
[2] Adebamowo CA, Casper C, Bhatia K, Mbulaiteye SM, Sasco AJ, Phipps W, Vermund SH, Krown SE. Challenges in the detection, prevention and treatment of HIV-associated malignancies in low-and middles income countries in Africa. J Acquir Immune Defic Syndr. 2014;67(1):S17–27. https://doi.org/10.1097/QAI.0000000000000255.
[3] Kuguyo O, Matimba A, Tsikai N, Magwali T, Madziyire M, Gidiri M, et al. Cervical cancer in Zimbabwe: A situation analysis. Pan Afr Med J. 2017;27:215. https://doi.org/10.11604/pamj.2017.27.215.12994.
