Health expert calls for robust funding streams to escalate treatment of cancer

A seasoned global health specialist has called for innovative and robust funding streams to escalate the treatment of cancer in Zambia.

Sarbani Chakraborty, representing the Union for International Cancer Control (UICC) and the Access to Oncology Medicines Coalition (ATOM Coalition), said on Monday that there was need to advocate for dedicated cancer funding within the National Health Insurance Management Authority (NHIMA) and to explore earmarked taxes such as tobacco to support cancer care.

During a Health Financing Workshop between the Ministry of Health and the UICC/ATOM Coalition, Dr Chakraborty suggested the need for expansion of coverage by NHIMA.

She said there was need for stakeholders to collaborate with NHIMA to explore benefits package expansion, pricing, and reimbursement options for oncology medicines.

Currently, Zambia’s health sector is highly depended on the working class who contribute about 42 percent of health funding.

Donor-sourced funding has limited funds for non-communicable diseases such as cancer.

Zambia has a high cancer burden, with 2020 data showing 13,831 cases with an incidence rate of 153.5 per 100,000 while mortality rate is 103.3 per 100,000 (8,672 deaths).

According to geographic distribution, Lusaka has the highest prevalence at 281/100,000), Eastern Province (165/100,000), and Central (125/100,000) provinces.

The most prevalent cancer types are cervical (23 percent), kaposi’s sarcoma (16 percent), prostate (11.2 percent), breast (seven percent), and oesophageal (3.7 percent).

Dr Chakraborty observed that NHIMA has limited reach to the informal sector, hence the need for additional financing mechanisms.

The two-day workshop which attracted representatives from various organisations in the country’s health sector noted the need for timely and adequate budget releases as well as the need for increased financing from treasury and ensure that funding is released timely to facilitate procurement process by the Zambia Medicines and Medical Supplies Agency (ZAMMSA).

At the national level, cancer medicine funds in Zambia are drawn from the government health budget, NHIMA, and donor-funded programs, but these operate separately with limited coordination, leading to gaps in service and coverage.

NHIMA provides basic coverage, while advanced treatments are budgeted for abroad separately often depend on donor funds or out-of-pocket payments, which are inconsistent.

There are significant delays in executing budgets for cancer services and medicines often occur due to bureaucratic processes at ZAMMSA as well as slow disbursement of funds, and procurement inefficiencies.

These delays directly impact the availability of cancer medicines, leading to frequent stockouts in public health facilities forcing patients to either wait for extended periods or seek alternatives in either private pharmacies or NHIMA accredited pharmacies.

This increases the out-of-pocket expenditures, especially for low-income patients, and limits access to timely treatment which can worsen their health outcomes.

Recommendations included strengthening procurement and access, including collaboration with international suppliers for framework agreements to secure timely medicine supply.

Currently, only 40 percent of essential cancer medicines are regularly available due to supply chain and regulatory challenges.

Of the 13 World Health Organisation (WHO) Essential Medicines List (EML), only seven drugs for breast cancer are included in the country’s EML.

The workshop also expressed the need to expand decentralised care by building regional cancer care capacity, specifically in Ndola and Livingstone, to ease pressure on Lusaka’s Cancer Diseases Hospital.

There is also need to review legislation to facilitate more efficient procurement.

High registration costs was cited as barrier to cancer treatment.

Currently, there is a fee of US$2,000 per dossier plus site inspection fees restrict market entry for oncology medicines.

There is also need to revise the Public Procurement Act to shorten the process used for procurement of essential medicines

Zambia’s essential medicines list lacks critical drugs like Trastuzumab for breast cancer due to limited registered medicines.

The Zambia Medicines Regulatory Authority’s small staff faces challenges in assessing biological medicines harmonisation with WHO pre-qualification.

Lack of price controls markups in Zambia has also exposed the country’s regulatory gaps.

By Benedict Tembo