Transcript Experience of MEWATA, Dr. Serafina Mkuwa

National Advocacy
Experience of MEWATA
11th Sept 2014
Introduction
 Medical Women Association of Tanzania an affiliate of
MWIA
 Established 1987, Registered 1989 Professional NGO
 Comprising of Female Medics (MD, DDS, AMOs,
ADOs, Female Medical Students) with > 300 female
doctors
 HQ in Dar es Salaam, with zonal branches/chapters
4/12/2015
2
MEWATA …
Vision:
Mission:
• Tanzanian medical women
• To promote professional
excelling in medical and
dental ethics with
attainment of quality
health interventions
development of women
medical and dental doctors
for better delivery of
quality health services
for women of Tanzania
4/12/2015
3
Overall Goals for MEWATA
• To contribute to national efforts of capacity development of health
sector with particular focus on female medical professionals and
health delivery systems
• To contribute to the improved quality of life and social well being of
Tanzanians, with particular focus on women, young people,
children and men
4/12/2015
4
Strategic plan
REPRODUCTIVE
HEALTH: MNCH,
GBV, Adolescent
sexual health &
reproductive
system cancers
HIV/AID:
discordant
couples, male
involvement in
PMCT &FP
Professional
development:
members and
institution, ethics
and standards
Thematic
areas
20112013
4/12/2015
5
Strategies…
 Advocacy
 Capacity building
 Research and publication
 Partnerships
4/12/2015
6
Role of advocacy
 Regular screening cancer is not conducted routinely in
PHC
 Bureaucratic referral system which is already broken delays
women access to care and treatment for breast and
cervical cancer
 Women with cancers faces an uphill battle to treatment at
the only one cancer hospital in the country
 Ocean Road Cancer Institute reported an alarming
increase in patients with cancers especially breast cancer
4/12/2015
7
Role …
 Awareness and understanding of the general population on
reproductive system cancers is low
 Myths and misconceptions are high concerning cancer diagnosis
(biopsy) and cancer care and treatment
4/12/2015
8
Methodology
Awareness
campaigns
and
community
mobilization
HW capacity
building
Service
provision
Screen,
diagnose and
treat
Refer to
tertiary care
4/12/2015
9
Awareness Campaigns
 Large campaigns – began 2005 (small campaigns
1993 and 1994)
 Conducted at Regional and District levels
4/12/2015
10
Capacity Development
 During each campaign MEWATA offers training to its
doctors and other HCPs
 On all aspects of breast and cervical cancer from health
promotion and prevention to diagnosis and treatment and
life after diagnosis
 Further training to doctors from the regions who will be
involved in surgeries
 Leadership skills also imparted to MEWATA members
during the campaigns
4/12/2015
11
Mobilize Resources
 Financial Resources
 Public Donations – general population, private organizations, churches,
and many other health stakeholders through the TV – three campaigns
 GOT through the MOHSW – supported fully two campaigns
 Air time by the TV/Radio stations
 Human Resources
 Female medical doctors volunteering to travel from Dar to the regions and
districts
 Male Doctors from Tanzania Surgical Association and also anesthetists
from Muhimbili National Hospital and Muhimbili University of Medicine
 Doctors, nurses and support staff available at the centers
 Members from Tanzania Breast Cancer Foundation – breast cancer
survivors
4/12/2015
12
Phases of the Campaigns
 Three Phases Campaigns:
Phase I. Awareness and Mass Screening
Phase II. Clinical Diagnosis
Phase III. Treatment and Palliative Care
4/12/2015
13
Phase I - Awareness and Mass Screening
 TV and Radio sessions on breast and cervical
cancer (live sessions with Q and A)
 Print news paper articles
 Fliers distribution on breast and cervical cancer
 Importance of BSE, BCE and Cacx screening to
women usually emphasized
4/12/2015
14
Phase I ctn..
 Address the issue of stigma, myths and
misconceptions on diagnosis and treatment of
cancer
 Publicize the campaigns widely well in advance
 Partner with TV and Radio stations
 Ensure large participation by women
4/12/2015
15
Phase II – Clinical Diagnosis
 Two weeks later
 Diagnosis – Fine Needle Aspiration and Cytology
 Surgeries lumpectomies, excisional biopsies
 Partner with Tanzania Surgical Association, District
and Regional Hospitals as Government and in
some areas FBOs facilities
4/12/2015
16
Phase III –Treatment and Palliative
Care
 Usually takes three to four months to be completed
 Major surgeries e.g. mastectomy, ductal
exploration, cosmetic surgeries etc
 Referral to ORCI or treatment at surgical
departments in respective regional hospitals
 Partner with Tanzania Surgical Association,
Regional Hospitals as Government and in some
areas FBOs facilities
4/12/2015
17
Results of the Campaigns
So far 9 Regions (Dar,
Mwanza, Mbeya, Lindi,
Mtwara,
Dodoma,
Manyara
and
Kilimamjaro TABORA)
4/12/2015
18
Findings: Distribution of Participants
S/n Region
Year Screened
Problems
Breast CA
1 Dar
2005
7259
751
46
2 Mwanza
2006
11668
871
25
3 Mbeya
2007
2008
513
150
27
4 Lindi
23102
5005
5 Mtwara
2008
8028
220
12
6 Dodoma
2008
6875
338
25
7 Manyara
2008
8 Kilimanjaro 2012
2046
142
9
1293
154
9 Mwanza
Tabora
10
TOTAL
8
15
2014
5 228
142
9
2014
5933
149
14
71209
3430
190
4/12/2015
19
Successes
1. Community mobilization, health education and awareness
programme
2. Campaigns enabled women to receive free screening
services, surgical investigations and treatment
3. Generally, the awareness of the society on breast
problems especially
tremendously
breast
cancer
increased
4. Awareness and understanding about breast cancer
increased within the Government from the level of the
Ministry of Health and Social Welfare (MOHSW) as well
as Regional and Local government authority
4/12/2015
20
Successes
5. Increased awareness about breast cancer and its clinical
and non-clinical treatment among health workers in health
facilities in the respective districts that benefited from the
programme
6. The philanthropy of financial contributions to solve health
problems was introduced in our society and was well
accepted by the public
7. Solidarity to provide services together increased
tremendously and each felt has a responsibility into the
matter
8. MEWATA was able to improve its partnership with other
4/12/2015
stakeholders
21
Challenges
 Operational challenges:
1. Lack of Mammography machine in many hospitals in Tanzania
especially in the regions
2. Geographical locations of regional hospitals where major
surgeries takes place
3. Lost to follow-up in Phase II and III high
 Society challenges:
1. Advanced stages of cancer diagnosis – poverty and the
bureaucracy of referral system
2. The exercise influenced the society on the need of this
screening service and many women are currently demanding to
be screened in various health facilities
3. Mass breast cancer campaign is costly – financial constraints
4/12/2015
22
Challenges
• Health Systems and Policy challenges:
1. The sustainability of the exercise, there is need to be
incorporated into their district council annual health plans
and be sustainable rather than to be left as the sole
responsibility of MEWATA.
2. The health policy on exemption to cancer patients
However recurrent stock-outs - MEWATA decided to cover
the cost for cancer drugs for the women who were found
with breast cancer but this was not sustainanble.
4/12/2015
23
Challenges cont…
3. According to the National Reproductive and Child Health
strategy and package developed by MOHSW, all women
are expected to be screened by health service providers
for breast and cervical cancer. However this is not the
case in reality.
4. Importance of having mammography machines in various
regional hospitals in the country need to be emphasized
5. Evaluation of the programme
4/12/2015
24
What Program did
 MEWATA programme has ensured:
 Availability of screening services to women
 Physical Accessibility + Information
 Economic Accessibility (Affordability)
 Acceptability - ethically and culturally fine
 Good quality services – skilled medical personnel,
equipments
4/12/2015
25
Way Forward
 MEWATA is still seeking opportunity of extending its
services in the country
 Embark into all the strategies for cervical cancer
prevention through strengthening the health system in
addressing cancer related challenges.
 MEWATA Well Women Health Center – screening,
diagnosis and non radiation cancer treatment
4/12/2015
26
MEWATA
4/12/2015
4/12/2015
31
31