Improving Access to Care Through Community Engagement: Zambian Case

Background and context: Zambia has total population of 16,405,229, life expectancy at birth is 53.3% and HIV prevalence rate is 13.3%. Though established in November 1977, the Zambia National Cancer Registry was only enhanced in 2015 leading to the publication of the 2008-2012 report. The overall age-standardized cancer incidence rate for both sexes in 2012 was 136.2 per 100,000 for all cancers, mortality rate was 104.9 per 100,000 71% these being new cancer cases due to patients presenting late with advanced disease. Aim: Increasing awareness and access to cancer care services within the existing health care and community-based systems in addressing the barriers to accessing care. Strategy/Tactics: Designed village-based screening program to provide services to the women in rural and hard to reach areas. Formulate a multisectoral approach engagement of the Ministry of Chiefs and Traditional Affairs (MOCTA) and Ministry of Local Government and Ministry of Education Formulated a VBS national roadmap based on: National Cancer Register Report (2012) and national geographical mapping of breast and cervical cancer clinics. Program/Policy process: Developed and signed a memorandum of understanding with Ministry of Chiefs and Traditional Affairs (MOCTA). Outcomes: Community engagement enabled easy flow of communication to all key stakeholders on the upcoming VBS activities within their area at all levels. Enabled easy acceptance of health education meetings by all key stakeholders to seek leadership buying and support, share VBS objectives and strategic planning of a successful community-based screening program in their area. Community awareness process: training/orientation: community health care workers (CHW) are trained on key messages on breast and cervical cancer and community-based referrals to health centers. Community sensitization: conducted by trained CHW and program staff through: PA announcing, one-to-one and focused group discussions. Developed referral systems: community based: trained community health care workers sensitize clients, clients who accepts to undergo screening are referred to the nearest screening clinic. Clinic based: trained health care workers screen clients those with positive findings are referred. Breast cancer screening: referred to the provincial hospital. Cervical cancer screening: eligible treated. Not eligible referred for further investigation (LEEP/biopsy) to the provincial hospital. What was learned: Engagement of key community stakeholders, multisectoral approach, strategic scale up of breast and cervical cancer services (HR, diagnostic equipment, pathology), standardized referrals systems at all levels (community, district and provincial), strategic continuous health promotion activities and advocacy, implementation of National Cancer Control Strategic Plan, monitoring and evaluation.