A new research study, led by scholars at the University of Cape Town (UCT), revealed that public sector health facilities in Southern Africa are not prepared to detect and diagnose early stages of cancer.
The research study is titled “Health facility preparedness for early detection of symptomatic cancer in Southern Africa: A multi-centre, cross-sectional study”. It is the first of its kind to systematically evaluate health system preparedness for early cancer detection across referral pathways in Southern Africa. The study focused on three of the most common cancers affecting the region: breast, cervical and colorectal cancers.
“Early diagnosis is one of the most important determinants of cancer survival. Yet, in many African settings, patients are diagnosed at advanced stages, when treatment options are limited,” said lead author, Associate Professor Tasleem Ras, the head of UCT’s Department of Family, Community and Emergency Care.
Deficiencies in health systems
The study was published in PLOS Global Public Health and assessed 34 public sector health facilities across the Western Cape and Eastern Cape provinces in South Africa, as well as across Harare and Bulawayo in Zimbabwe. The study examined how well these facilities are equipped to identify, diagnose or refer patients with symptoms suggestive of cancer. The research formed part of the African Awareness of Cancer and Early Diagnosis (AWACAN-ED) programme. AWACAN-ED is a global health research group funded by the National Institute for Health and Care Research.
Professor Ras said his study highlights important systemic deficiencies in health systems and exposes stark differences between levels of care (primary, secondary and tertiary) between both countries, as well as both provinces in South Africa.
“This research offers a detailed picture of where the gaps are and where interventions can have the most impact.”
The research found that primary healthcare facilities, often the first point of contact for patients, showed limited capacity for early diagnosis. He said staffing levels were low, with very few doctors available in many facilities, especially in rural areas. In addition, many remote areas also lacked adequate communication infrastructure, which makes it difficult to refer patients to specialists. This was further compounded by a shortage of elective transport. In some areas, he said, ambulances were reserved for emergency cases only.
What all this means, Ras said, is that it takes patients weeks and sometimes months to get to a specialist hospital for a definitive cancer diagnosis. Therefore, diagnoses are made at a much later stage of the disease. He noted that while specialist hospitals are better equipped than primary healthcare facilities, healthcare workers reported inequity with access to diagnostic equipment. In particular, he said, mammography – an essential element for a breast cancer diagnosis – was not available in any of the Zimbabwean hospitals surveyed. Interestingly, he added, health facilities also ran more awareness campaigns for cervical and breast cancer when compared to colorectal cancer.
How to improve early cancer diagnosis
Ras said the study recommends several strategies health facilities in resource-constrained settings should implement to improve early cancer diagnosis:
- Strengthen general cancer-specific infrastructure, especially in remote primary healthcare facilities.
- Leverage available technology to enhance record-keeping and communication across all levels of care.
- Enhance delivery and coordination of care by co-developing localised clinical protocols and follow through on context-specific implementation plans for these protocols.
- Develop and implement rapid transit care pathways for patients with suspected cancer from primary care to appropriate specialist services (and back), supported with reliable transport for non-emergency patients from remote areas.
“This research offers a detailed picture of where the gaps are and where interventions can have the most impact. It gives policy makers, clinicians and researchers a roadmap for strengthening cancer care systems in the region,” Ras said.
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