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

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MEWATA …Vision:

• Tanzanian medical women excelling in medical and dental ethics with attainment of quality health interventions

 

Mission:

• To promote professional development of women medical and dental doctors for better delivery of quality health services for women of Tanzania

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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

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Strategic plan

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Strategies…Advocacy

Capacity building

Research and publication

Partnerships

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Role of advocacyRegular 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

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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

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Methodology

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Awareness CampaignsLarge campaigns – began 2005 (small campaigns

1993 and 1994)

Conducted at Regional and District levels

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Capacity DevelopmentDuring 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

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Mobilize ResourcesFinancial 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 campaignsAir time by the TV/Radio stations

Human ResourcesFemale medical doctors volunteering to travel from Dar to the regions and

districtsMale Doctors from Tanzania Surgical Association and also anesthetists

from Muhimbili National Hospital and Muhimbili University of MedicineDoctors, nurses and support staff available at the centers Members from Tanzania Breast Cancer Foundation – breast cancer

survivors

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Phases of the Campaigns

Three Phases Campaigns:Phase I. Awareness and Mass ScreeningPhase II. Clinical DiagnosisPhase III. Treatment and Palliative Care

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Phase I - Awareness and Mass Screening

TV and Radio sessions on breast and cervical cancer (live sessions with Q and A)

Print news paper articlesFliers distribution on breast and cervical cancer

Importance of BSE, BCE and Cacx screening to women usually emphasized

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Phase I ctn..Address the issue of stigma, myths and

misconceptions on diagnosis and treatment of cancer

Publicize the campaigns widely well in advancePartner with TV and Radio stations Ensure large participation by women

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Phase II – Clinical DiagnosisTwo weeks laterDiagnosis – Fine Needle Aspiration and Cytology Surgeries lumpectomies, excisional biopsiesPartner with Tanzania Surgical Association, District

and Regional Hospitals as Government and in some areas FBOs facilities

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Phase III –Treatment and Palliative Care

Usually takes three to four months to be completedMajor surgeries e.g. mastectomy, ductal

exploration, cosmetic surgeries etcReferral to ORCI or treatment at surgical

departments in respective regional hospitalsPartner with Tanzania Surgical Association,

Regional Hospitals as Government and in some areas FBOs facilities

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Results of the Campaigns

So far 9 Regions (Dar, Mwanza, Mbeya, Lindi, Mtwara, Dodoma, Manyara and Kilimamjaro TABORA)

Findings: Distribution of Participants

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S/nRegion Year Screened Problems Breast CA1 Dar 2005 7259 751 462 Mwanza 2006 11668 871 253 Mbeya 2007 23102 513 274 Lindi 2008 5005 150 85 Mtwara 2008 8028 220 126 Dodoma 2008 6875 338 257 Manyara 2008 2046 142 9

 8Kilimanjaro

2012 1293 154 15

9 Mwanza 2014 5 228 142 9

10Tabora

2014 5933 149 14

TOTAL   71209 3430 190

Successes1. 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 breast cancer increased tremendously

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

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Successes5. 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 stakeholders

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ChallengesOperational 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 system2. 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

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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.

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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

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What Program didMEWATA programme has ensured:

Availability of screening services to womenPhysical Accessibility + Information Economic Accessibility (Affordability)Acceptability - ethically and culturally fineGood quality services – skilled medical personnel,

equipments

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Way ForwardMEWATA 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

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MEWATA