Strengthening health systems to reduce inequality in access to childhood cancer services in Ghana

1. Strengthening health systems to reduce inequality in
access to childhood cancer services in Ghana
19th October 2017
Piera Freccero, George Achempim, Liz Burns

2. Background – The health partnership
Every year around 1,500 children will develop cancer in Ghana
Objective: improving the quality of care of children with cancer in
Ghana
World Child Cancer has promoted a partnership between the Royal
Hospital of Sick Children in Edinburgh and the Teaching Hospitals in
Accra and Kumasi started in 2010.
3 years DFID funded project from 2014

3. Background
Specialised paediatric oncology training and mentoring for health care
professional working at the teaching hospitals
Bi-Annual Twinning Workshops: 282 people trained ( April 2014–
March 2017) in specialised PO
416 healthcare staff trained on childhood cancer diagnosis and
treatment
Internships: 19 people attended internships (local and international)

5. Background
Psycho social support for carers and families
2 parents supports groups formed
484 parents benefited from fundraising and psychosocial support
trainings.
Income generation activity: 24 people trained in income generation
activity
Support groups activities: Donations to new families, awareness
raising, pursuit of construction of parents hostel at KBTH
Fund raising: Over GHS 300,000 (USD 75,000) raised by parents over 3-
year period to fund parents hostel construction

7. Infrastructure –Day Care Unit
• Before (2012) • After (2013)

8. Achievements!
• Treatment Abandonment Reduced from 62% to 12%.
• 1-year event-free survival rates have increased from 20% to 65%.
• Number of paediatric oncologist in Ghana increased from 3 to 5.

9. But…
Every year around 1,500 children will develop cancer in Ghana
Diagnosis at KBTH & KATH (April 2014 – March 2017)
Year 1 – 282 children diagnosed with all cancers
Year 2 – 310 children diagnosed with all cancers
Year 3 – 309 children diagnosed with all cancers
where are them?!

10. The Study
Explore socio-economic factors that limit access to quality childhood
cancer services in Ghana
Database (regional, gender, economic barriers)
1423 children accessed service from 32010 to 2016 (15.4% of the
expected cases)

11. The Findings
Gender not represented equally: 57% cases male, 43% female
Impressive inequalities in the geographical distribution: more than half
(52%) of the children that accessed treatment services lived in the two
regions where the treatment centres are located, but the three regions
in the north of Ghana – the one with the highest poverty rates in the
country (UNICEF, 2016)– contributed with less than 4% of the patients.

12. Childhood cancer cases presentation per region
Table 1: Childhood cancer cases per regions in Ghana (2010 to 2016
Regions
Year
Total
% of cases
per region
Annual
average (2014
to 2016)2010 2011 2012 2013 2014 2015 2016
Ashanti 51 59 63 65 94 61 77 393 28% 77
Brong Ahafo 30 14 14 17 21 22 16 118 8% 20
Central 18 19 21 22 20 25 28 125 9% 24
Eastern 20 38 39 22 25 32 26 176 12% 28
Greater Accra 43 60 55 53 64 73 96 348 24% 78
Northern (N) 3 8 9 10 6 3 6 39 3% 5
Upper East (N) 2 8 4 1 3 6 2 24 2% 4
Upper West (N) 4 2 0 2 0 6 3 14 1% 3
Volta 11 8 13 11 8 16 14 67 5% 13
Western 16 22 20 15 19 27 16 119 8% 21
Total 198 238 238 218 260 271 284 1423 100% 272

13. Table 3: Proportion of Children (0-14) by region, at risk and children using cancer treatment services
Regions
Total
Population of
Region
Population 0-14 years
Total
population
(0-14 Years)
– At risk pop
Proportion likely to
develop cancer
(n(T)/1,000000*140)
Average of
children Accessing
treatment yearly
% of Service
Utilization
(RT/Estimated*
100)
Male Females
Western 2,376,921 470,537 455,977 926,514 130
21 16
Central 2,201,863 441,949 429,885 871,834 122
24 20
Greater Accra 4,010,054 620,036 633,596 1,253,632 176
78 44
Volta 2,118,252 413,959 398,866 812,825 114
13 11
Eastern 2,633,154 518,978 492,076 1,011,054 142
28 20
Ashanti 4,780,380 911,066 892,852 1,803,918 253
77 30
Brong Ahafo 2,310,983 460,966 455,766 916,732 128
20 16
Northern (N)* 2,479,461 570,021 540,592 1,110,613 155
5 3
Upper East
(N)*
1,046,545 224,263 210,356 434,619 61
4 7
Upper West
(N)*
702,110 151,210 141,488 292,698 41
3 7
Estimated
Cases
Nationwide
(Annual)
1321 273.0
*N= the three northern regions

14. Reflection & Action
Strengthening the shared-care
network
Strengthen the long term
sustainability of the partnership by
enabling locally led specialised
paediatric oncology trainings for
health care staff working in the
identified shared care facilities
Develop a shared-care centre into a
hub in the north (Tamale)

15. Reflection & Action
National Early Warning Signs
campaign – new partnerships
• Developed a plan with the
partners and the NCD office of
the Ghana Health Service to train
health care staff in 10 regional
hospitals in Ghana in EWS and
referral pathways
• National gender sensitive
awareness campaign in
collaboration with the National
Coalition of NGOs working in
Health

16. New project
• The new strategy has been developed into a project proposal that
has been successfully granted a new Dfid UK Aid Match Grant

17. Learning
• Improving quality of the service does not automatically mean
improving access
• Improving access requires different strategies in particular it requires
different partnerships
• The involvement of the civil society is crucial to identify barriers to
access and address them

18. Thank you!