Pakistan has no policy framework for cancer control

Islamabad : Pakistan’s political government, which based its election campaign on building a charity cancer hospital in the private sector, is yet to deliver even a policy framework for the prevention and control of cancer.

The country has 25 cancer hospitals for a population of 220 million; of these 18 have been established by the Pakistan Atomic Energy Commission and none qualifies as a comprehensive cancer care hospital with radio diagnostic facilities, chemotherapy and radiotherapy, surgery including organ transplants, and end of life care—all under one roof. While PAEC hospitals do not offer the facility of surgeries, Shaukat Khanum Memorial Hospital, Shifa International, and Aga Khan University Hospital do offer surgeries and transplants, but do not have hospice facilities. As such, there is no comprehensive cancer care hospital in Pakistan, either in the private or public sectors.

Pakistan also does not have a national cancer registry or consolidated data on cancer patients. Such registries systematically collect, analyze and interpret data on cancer cases, both for epidemiological research purposes, as well as evaluation of health services in terms of prevention, diagnosis, and treatment. A wrong assessment of the cancer burden can have serious implications for resource-constrained countries like Pakistan, where health remains a neglected priority in terms of budgetary allocations. The Pakistan Health Research Council also did some spadework for the establishment of a national cancer registry but that was about all.

The situation of cancer care is further compounded by the dearth of qualified oncologists. The federal government’s total capacity to fight cancer comprises one professor, one assistant professor, four medical officers, and eight hospital beds.

The erstwhile Capital Administration and Development Division (CADD) did make an effort to bring Pakistan on board with the International Atomic Energy Agency under the imPACT initiative which supports countries in their efforts to improve comprehensive cancer control. Up until 2018, some progress was made. However, with the focal point posted out of the technical position, the entire initiative is now rusting in the archives of the Ministry of National Health Services.

The few efforts made before 2018 included notification of a National Steering Committee under the chair of the Minister of State; submission of nominations by all provincial health departments; and holding off the Committee’s first meeting in 2016 with then Minister of CADD Barrister Usman Ibraheem in the chair. The only material progress, however, was witnessed on the preventive side with the development of ‘Tobacco Smoke-Free Cities’ model, which paved the way for the district administration to implement tobacco control laws.

Starting off from Islamabad in 2014, the Tobacco Smoke-Free Cities model is currently being replicated in 12 districts across Pakistan. The model’s highlights, which include tobacco vendors’ licensing, inclusion of tobacco control in the drug control paradigm of the Anti-Narcotics Force, and establishment of tobacco control cells in the offices of the district governments are being keenly followed and appreciated by advocates of tobacco control across the globe.

Dr. Minhaj us Siraj, who is leading the COVID-19 frontline warfare at the Pakistan Institute of Medical Sciences as Joint Executive Director, has been spearheading these efforts relentlessly. However, Pakistan still has a long way to go before it can truly claim a breakthrough in its fight against cancer. Without a national policy for cancer control, a national cancer registry, and without a comprehensive infrastructure for treatment, cancer control remains a distant dream only.

The annual wake-up call given on World Cancer Day each year continues to be conveniently taken by successive governments, the present one being no exception. With a Prime Minister who has devoted several decades of his life to cancer control, there can be no better time to walk the extra mile and institute lasting measures to rid Pakistan of the rising burden of cancer.