National Advocacy Experience of MEWATA 11 th 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 5/6/2015 2

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 5/6/2015 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 5/6/2015 4

Strategic plan Thematic areas 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 5/6/2015 5

Strategies… Advocacy Capacity building Research and publication Partnerships 5/6/2015 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 5/6/2015 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 5/6/2015 8

Methodology Awareness campaigns and community mobilization HW capacity building Service provision Screen, diagnose and treat Refer to tertiary care 5/6/2015 9

Awareness Campaigns Large campaigns – began 2005 (small campaigns 1993 and 1994) Conducted at Regional and District levels 5/6/

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 5/6/

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 5/6/

Phases of the Campaigns Three Phases Campaigns: Phase I. Awareness and Mass Screening Phase II. Clinical Diagnosis Phase III. Treatment and Palliative Care 5/6/

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 5/6/

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 5/6/

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 5/6/

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 5/6/

5/6/ Results of the Campaigns So far 9 Regions (Dar, Mwanza, Mbeya, Lindi, Mtwara, Dodoma, Manyara and Kilimamjaro TABORA)

Findings: Distribution of Participants 5/6/ S/nRegionYearScreenedProblemsBreast CA 1Dar Mwanza Mbeya Lindi Mtwara Dodoma Manyara Kilimanjaro Mwanza Tabora TOTAL

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 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 5/6/

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 stakeholders 5/6/

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 5/6/

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. 5/6/

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 5/6/

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 5/6/

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 5/6/

5/6/ /6/ /6/ /6/ /6/ MEWATA