David Makumi (1) Elizabeth Abongo (2) Lawrence Gichini (3)

1. When the Hospital goes to the Shopping Mall! Building Partnerships with Community Institutions in Cancer Control David Makumi (1) Elizabeth Abongo (2)  Lawrence Gichini (3) 1, 2,3, The Aga Khan University Hospital, Nairobi.

3. Objective. Describe a low cost model of cancer control by availing specific services in shopping malls and community centers.

4. Background: Kenya Some Health indicators • Population 39 million • Life expectancy at birth: Male: 52 Female: 55 • Total expenditure on health as % of GDP 4.3% • Risk of getting cancer before age 75: 14.1% • Risk of dying from Cancer before age 75: 12% • Medical oncologists: 3 • Radiation Oncologists <20 Source: WHO Statistics 2010 Globocan 2008

5. Cancer background: I • Double burden of Non communicable and Communicable diseases in compounded by poor access to healthcare. • Breast, Cervical, GIT cancer are top two cancers in women, H&N, Prostate and GI top in Men • 80% of Women present with stage 3 or 4 disease. Nairobi Cancer Registry 2006

6. Cancer: background Reasons for late diagnosis. • Lack of knowledge by the population about the symptoms. • fear, denial and a fatalistic attitude towards cancer. • Belief in traditional medicines. • Lack of Access to Screening: =Affordability. =Acceptability. =Availability. Nairobi Cancer Registry 2006

7. Justification • Problem of large-scale ill health in rural and urban Kenya not primarily a technical-medical issue. • Key requirement to meeting the health care needs of urban dwellers is not just newer medical technologies, but a culturally acceptable cost effective innovative cancer control . Why community centres? = Devoid of the impersonal, intimidating hospital atmosphere =Provide a more women friendly environment. =Clients are in control

8. Material & Methods. To be successful, the screening program used a public health model • Aimed at Good population coverage for screening. • Respect for the local customs, dignity, privacy and autonomy of the women and Involved grass root women right from the planning stages. • All women had clinical breast examination and were taught self breast examination during the encounter with a health care provider and given essential information on risk reduction. • Self administered questionnaire on her breast health and risk assessment. • Data on clinical findings entered and analyzed using SPSS.

9. Need for Cancer Control Interventions Model • PUBLICITY • Media • Fliers • Churches • communities • INCENTIVES. • Discounted breast imaging / pathology rates. • FREE C.B.E. • One to One encounter with health providers • cancer information • Education & information material REFFERALS FOLLOW-UP

12. Findings • This is an ongoing program. 8000+ women have been screened through clinical breast examinations in retail outlets over the last 24 months.. • 15% of the women presented with breast problems such as fixed lumps with lymph nodes and bloody nipple discharge. • 20% have done mammograms which they would not have otherwise done. • Other health concerns are also addressed. • The project is ongoing.

13. Age distribution

14. Have you ever had a nurse or a doctor examine your breast? • 70% have Never had a CBE. • ? Lack of awareness on both HCP & Client. • ? Failure of health professionals.

16. Discussion • Need for health planners, policy makers, and other stakeholders to engage and involve communities in designing new and innovative cost effective health care delivery models is Urgent. • Populations buy into Cancer Control interventions when implemented at community level. • Clinical Breast Examination are a suitable option for countries in economic transition, where incidence rates are on the increase but limited resources do not permit screening by mammography

17. Conclusion • Urban areas face a myriad of health challenges from rapid population growth, pollution, unplanned settlements, and an increase in both communicable and non communicable diseases. • A model of partnering with the community institutions in implementing cancer control interventions will help address the unfolding cancer epidemic at community level

18. This is where effective cancer control starts. Thank you

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