Primary health centres are increasingly seen as the future of cancer response strategies, especially for children. In Nigeria, they are set to play a vital role in improving early detection and community awareness in the country’s fight against childhood cancer.
Primary health centres in Nigeria play a critical role in early detection and support for children with cancer and their families. Photo: Paul Adepoju
On a warm April afternoon, stakeholders from across Africa convened in Dar es Salaam, Tanzania, for the first International Conference on PEN-Plus in Africa (ICPPA 2024). The focus was clear: to facilitate quality care at community health centres in order to better treat common non-communicable diseases (NCDs).
A side event that focused on cancer highlighted the myriad issues that various cancers present to national and local health systems. The consensus was clear: Primary health centres are the future of cancer response strategies, especially for children.
Childhood cancer remains a significant cause of morbidity and mortality worldwide, with stark disparities between high-income countries and low- and middle-income countries (LMICs). In Nigeria, Africa’s most populous country, the situation is dire. Primary health centres are the first line of defence for most health issues, but they are largely ill-equipped to handle complex conditions like cancer. The lack of specialised diagnostic tools, such as MRI and CT scans, coupled with a shortage of trained healthcare professionals, creates a formidable barrier to early detection and treatment.
Dr Victoria Feyikemi, a general medical practitioner in Ibadan, Nigeria’s third-largest city, who began her career as a community health worker, was among the attendees at the conference. She emphasises that early detection is crucial for improving survival rates in childhood cancer. However, in Nigeria, the high prevalence of malaria often leads to misdiagnosis.
“Many children are repeatedly treated for malaria when they might actually have cancer,” she explains. This misdiagnosis delays crucial cancer treatments, worsening the prognosis for young patients.
Upskilling healthcare workers at the frontline
Just a couple of kilometres from Nigeria’s seat of power in the capital city of Abuja is Amac Primary Health Care, Lugbe. The centre is a beehive of activity on Thursday mornings at the antenatal clinic. After a singing and dancing session that helps the women relax, one of the nurses on duty runs an informal information session covering a wide range of topics ranging from their health during pregnancy to that of other members of their families.
Primary healthcare workers are often the first point of contact for children with potential cancer symptoms and their families. While explaining that their lectures may not check all the boxes of thorough childhood cancer education, nurse Mojisola Adeosun says the centre’s approach is geared towards creating an environment where the women and their family members can open up about any health issues.
"Considering the very limited capacity we currently have, our best shot for now is emphasising prevention, encouraging good lifestyle choices, and targeting early detection to improve outcomes.”
“Considering the very limited capacity we currently have, our best shot for now is emphasising prevention, encouraging good lifestyle choices, and targeting early detection to improve outcomes,” she says.
Adeosun is one of several primary healthcare workers at the centre who received training to communicate and recognise early signs of cancer. “Specialised training programmes can help primary healthcare workers recognise early signs of cancer and understand referral pathways,” she explains.
“Ensuring continuous education and updates on the latest paediatric oncology practices for healthcare workers in local communities is also essential. This approach ensures that primary healthcare workers are well-equipped to handle the complexities of childhood cancer care.”
Nurse Mojisola Adeosun delivers a health information session to pregnant women at Amac Primary Health Care, Lugbe. Photo: Paul Adepoju
Feyikemi agrees specialised training programs and continuous professional development can equip these workers with the knowledge needed to make accurate referrals. “It’s about empowering the frontline workers with the right tools and knowledge,” she asserts, explaining that this approach helps children with potential cancer symptoms receive timely and appropriate referrals to specialised care.
While Nigeria faces significant challenges in delivering childhood cancer care, there are pockets of innovation and hope. The NSIA-LUTH Cancer Centre in Lagos is a public-private partnership that boasts modern linear accelerators (LINACs) and advanced radiation therapy techniques that children diagnosed with cancer can be referred to for treatment. This referral model is being encouraged for replication across the country to enhance cancer care infrastructure.
Building critical community awareness
Community awareness is another vital component of early detection. Feyikemi and Adeosun agree that educational campaigns can inform the public about the early signs of childhood cancer, encouraging parents to seek medical advice sooner. They see primary health centres as uniquely positioned to serve this purpose as part of their community outreach initiatives and other community activities that can further amplify the message.
“Increased awareness among the public can lead to earlier detection and better outcomes for children with cancer. Local support systems are equally important,” Adeosun says.
School and community programmes can integrate cancer education to ensure widespread dissemination of information. By making cancer education a part of everyday learning, Feyikemi argues communities can become more knowledgeable and proactive in addressing childhood cancer.
For families with children who receive a cancer diagnosis, Feyikemi says primary health centres can provide much-needed emotional and logistical support.
“Psychoeducational programs, including play therapy and counselling, can help children and their caregivers navigate the challenges of cancer treatment. These programs offer a holistic approach to care, addressing not only the physical but also the emotional and psychological needs of young patients and their families,” she says.
Making childhood cancer a policy priority
For sustainable improvement in childhood cancer outcomes in Nigeria, policy development and resource allocation are essential. With funding for healthcare representing less than 5% of the country’s total budget for 2024—compared to the 15% proposed by African Union countries in the 2001 Abuja Declaration—childhood cancer and other pressing health issues compete for very limited funding.
“We know that the Nigerian government needs to prioritise childhood cancer in national health policies and ensure adequate funding for primary health centres. This includes investing in modern diagnostic and treatment equipment and maintaining their functionality,” Adeosun says.
“Without an intentional improvement in health funding, the fate of childhood cancer in Nigeria may heavily rely on the involvement of a donor or funder who is interested in addressing childhood cancers.”
Adequate government funding for primary health centres like Amac Primary Health Care, Lugbe is crucial. Photo: Paul Adepoju
Policies that support childhood cancer care at the primary healthcare level can drive significant improvements in survival rates and overall health outcomes. Earlier this year, at an event commemorating World Cancer Day held at the National Institute for Cancer Research and Treatment (NICRAT) in Abuja, the secretary for the Federal Ministry of Health and Social Welfare addressed the importance of early diagnosis and improving access to quality care.
It was announced that the government would help establish new radiotherapy facilities across the country, among other initiatives; this can reduce the long waiting times for radiotherapy treatment. However, healthcare experts still believe that more needs to be done to ensure these centres are fully operational and accessible to all who need them.
“Investment in infrastructure must be matched by investment in human resources; ensuring that primary health centres have the necessary equipment and trained personnel is crucial for effective cancer care.”
“Investment in infrastructure must be matched by investment in human resources; ensuring that primary health centres have the necessary equipment and trained personnel is crucial for effective cancer care,” Feyikemi emphasises.
Gathering data to transform cancer care
Critical, too, is integrating primary health centres into other arms of Nigeria’s healthcare system. Chris Chukwunyere, City Cancer Challenge city manager for Abuja, says Nigeria’s national cancer data may not currently capture information about parents who receive a diagnosis or seek treatment for their child’s cancer at primary health centres without accessing higher levels of care from general or tertiary hospitals.
“The goal is to improve the health information system and establish cancer registries that can collect data from primary care centres, in addition to general hospitals and tertiary facilities,” he says. “This would provide a more complete picture of the cancer burden in the country.
“Strengthening the role of primary healthcare in the cancer care continuum, and ensuring data is captured at that level, is seen as an important gap to address to improve cancer outcomes in Nigeria.”
With strategic improvements and dedicated efforts, Chukwunyere says significant strides can be made in early detection, referral, and comprehensive care for children with cancer. These efforts, if effectively implemented, promise to transform the paediatric cancer care landscape in Nigeria, offering better prospects for survival and quality of life for affected children and their families.
The discussions at ICPPA 2024 and other international events underscore the urgent need for a coordinated, multi-stakeholder approach to cancer care in Africa. In Nigeria, the ultimate aim is to ensure that every child with cancer has access to quality care and a fair chance at survival. As Feyikemi notes, “It’s about giving every child a fighting chance, no matter where they live or their economic status.”
With continued efforts and collaboration, she believes Nigeria can transform its paediatric cancer care landscape, serving as a beacon of hope and a model for other countries facing similar challenges.
“The journey is long, but the goal is clear: to build healthier societies where every child has the opportunity to thrive,” Feyikemi says.
Comments