During the 2nd week of October, 2021, a multi-disciplinary delegation of 7 health officials from the Ministry of Health DRC, The University of Kinshasa Hospital and Pallia Familli visited the Uganda Cancer Institute on an APCA organized experiential learning tour that comprised several other stops at different health institutions in Uganda.
The purpose of the study tour was to strengthen health systems in DRC as well as improve technical knowledge and capacity of health workers in DRC in the use of controlled medicines such as opioid analgesics and psychotropics for medical and scientific purposes.
The visit was coordinated by the African Palliative Care Association with funding from the Government of the Kingdom of Belgium through the United Nations Office on Drugs and Crime (UNODC) and in collaboration with the Ministry of Health of the Democratic Republic of Congo and Pallia Familli, a local civil society organisation working to improve access to palliative care in the DRC.
Delegates included the Deputy Director of the National Cancer Board in the Ministry of Health in DRC, Dr Innocent Kakese, the director in charge of locally produced medicines in DRC MoH, Ms Pascaline Diakanua, the director of the National Medicines Body Ms Ghislaine Mbelu, the head of the pharmacy at the University of Kinshasa Hospital, Mr Andre Katele, Dr Aaron Nshindi and Mr Anselme Kananga from Pallia Familli.
The visit to Uganda Cancer Institute included an interactive presentation from Dr Henry Ddungu, the head of the Hemato-oncology department at the institute, who narrated the history of the institute, and how it grew organically at the beginning, to a point where it was declared an independent body through an act of parliament in 2016 . This growth matrix was of particular interest to the DRC team as their country has a newly formed National Cancer Board which is looking to maximise on lessons learnt from Uganda’s experience.
Their many questions around regulatory documents, policy issues, and how the whole system is synergised were adequately addressed. Copies of the national strategic plan for cancer were shared with the team as a guide, together with the best practice of having a cancer registry for the population. The team learnt that the East Africa Community recognises the Uganda Cancer Institute as The Regional Centre of Excellence in Cancer, and so far steps have been taken with other African countries to develop harmonized guidelines on cancer for Sub-Saharan Africa. As such, the DRC’s learning curve need not be as sharp if they integrate lessons learnt from the experiences of other African nations.
On the subject of human resources and specialties, the team learnt how Uganda also started off with very few oncologists, and they used to send doctors to be trained in cancer specialties out of the country, but realised how ineffective that was given the few people who could go at a time, the cost of the effort and the high demand for them elsewhere. The Centre has now started running training activities and fellowships for the East African Region, where even DRC is capable of sending its cadres for training.
The Pain-Free Hospital Initiative (PFHI)
The team was challenged to learn about the Pain-Free Hospital Initiative (PFHI), a quality improvement initiative to integrate pain management into all cancer service delivery by providing education for staff, raising motivation and awareness, measuring and documenting pain levels, and improving medicine supply, including opioids, where necessary, in order to reduce pain-related suffering and distress for patients.
They covered, at length, the integration of palliative care as part and parcel of the essential basic health package in all health services within the greater Mulago National Referral Hospital, and also in the Uganda Cancer Institute.
The team paid site visits to different departments in the institute including;
- The pharmacy and drug reconstitution and storage facilities
- The radiotherapy department
- The paediatric cancer ward
- The Patient Navigation Centre
- The Fred Hutch Centre for Research
- Record-keeping and data management centre
Other best practices covered during the visit included the importance of ongoing research and the quest for evidence, partnerships and collaboration with other African and global cancer stakeholders, and the Patient Navigation System that ensures that no patients are “lost” before and after being at the institute. Engaging civil society strategically and effectively, and coordinated public-private partnerships were also noted as a best practice, particularly where patient welfare was concerned in a context of limited resources. The provision of all cancer services for free in Uganda was a key learning point for the team from DRC.
Overall, the tour sought to provide a holistic picture to the delegates as their country is looking to increase access to controlled medicines for the welfare of their patients in need while preventing diversion and non-medical use. The visit to UCI was a major contribution towards building the capacity of the healthcare professionals on tour to properly understand the importance of controlled medicines for medical purposes and to conceptualise how this can be implemented better in the DRC.
Access to controlled medicines
This study tour was part and parcel of an ongoing project that seeks to improve access to controlled medicines for French speaking African countries currently being implemented in the DRC with a view to expanding it to other francophone African countries. Its broader objective is to coordinate a worldwide response of UN member states to improve the management policies and procedures related controlled medication, particularly for prescription pain medication. The aim is to increase access to controlled drugs for medical purposes that serve to address severe pain, therefore reducing existing barriers and increasing the number of patients receiving appropriate treatment for conditions requiring the use of such medication, while minimising misuse and abuse.