Prevention and care: As non-communicable diseases rise, the government is investing in new specialist care facilities around the country

A rapid increase in cancer prevalence has been seen in Algeria over the last 20 years, which the government is working to combat. The Ministry of Health, Population and Hospital Reform reported over 40,000 new cases in 2012. Prevalence rates have risen from 80 cases per 100,000 people in the 1990s to 120 cases per 100,000 people by 2008, an increase of 50%. The change has been sparked by a number of factors, including demographic growth and urbanisation, changes in lifestyle and nutrition habits, and high smoking rates. In 2008 cancer accounted for 21% of total mortalities and one-third of mortalities related to non-communicable diseases among adults aged 30-70 years old.

Non-communicable diseases, including cancer, cardiovascular disease, diabetes and chronic respiratory conditions, represent the primary health challenge for Algeria. Local experts forecast that the cancer prevalence rate will increase to 300 cases per 100,000 population in the next decade, on par with the rates in France, the US and Canada today. The state has stepped up efforts to combat cancer in the last decade, but a lack of trained medical personnel, insufficient public health infrastructure, and low awareness levels have contributed to the disease’s impact.

However, the state is implementing a plan to construct 15 new oncology centres, acquire new testing and diagnostic equipment, train medical personnel and expand prevention efforts, which should help to address the key obstacles. While much work remains to be done, the programme has made progress in the last three years. In particular, new facilities and equipment scheduled to come on-line in 2013-14 should have a positive impact in the medium term.

NEW FACILITIES: The government’s 2010-14 national investment plan aims to construct 45 new specialised health centres, of which 15 will be devoted to oncology. Today, most diagnostic and treatment services are provided through large public hospital centres and six specialised clinics. Limited equipment and a shortage of specialised medical staff have created long wait times for crucial procedures. Local practitioners estimate that waiting times for breast cancer surgery can be up to eight months, and delays for many radiotherapy services can reach over one year.

REGIONAL CENTRES: The state originally aimed to push the number of cancer centres to 22 by 2014; while this goal is still a long way off, the inauguration of two regional cancer centres in Batna and Sétif should help to open up access to care in these areas. The Batna Anti-Cancer Centre (CAC) is opening in stages and will eventually serve Batna and five surrounding provinces. Its 90-bed day hospital opened in mid-2012 and provides diagnostic services and outpatient chemotherapy. Radiotherapy services were originally expected in 2012, but this has been pushed back to the first quarter of 2014 due to administrative delays and personnel shortages. The centre is expected to fully open by the end of 2013 with a capacity of 240 beds, and will provide a full slate of inpatient and outpatient diagnostic, treatment and surgical services.

The medical oncology ward of the Sétif CAC was inaugurated at end-October 2013 by Prime Minister Abdelmalek Sellal. The facility will open in stages; in addition to the oncology ward, Sétif will have capacities for radiotherapy, nuclear medicine and surgery. The design, construction and equipment of the 160-bed facility required an estimated AD4bn (€36.8m) investment. The CAC is expected to employ 18 medical specialists and 60 paramedical staff, but, as is true across the sector, recruiting qualified personnel will be a challenge.

Additional cancer centres in Annaba and Tlemcen are slated for completion in 2014, and studies have been commissioned for several other sites. Most recently, the ministry gave the green light to initial studies for a CAC in Oran, Algeria’s third-most populous province.

EQUIPMENT: The next challenge will be to ensure adequate equipment levels to respond to increasing patient demand. In September 2013 Algeria engaged two foreign firms – Sweden’s Elekta and US-based Varian Medical Systems – to provide the necessary radiotherapy machinery. The state has purchased several linear accelerators, which are expected to come on-line in Sétif, Batna and Annaba in February 2014, according to comments by the health minister, Abdelmalek Boudiaf.

SPREADING SERVICES: The new equipment will allow the Batna and Sétif CACs to launch their radiotherapy clinics, which should relieve some of the pressure on the Constantine hospital centre. Constantine has become the primary centre of care for cancer patients throughout eastern Algeria given the limited access to services. According to data supplied by provincial health officials, between 1200 and 1500 new cases of cancer are registered per year in Sétif, and 5000-6000 new cases are recorded annually throughout the Hauts Plateaux region, well beyond the capacity of the Constantine hospital centre. Once fully operational, the Sétif CAC will serve the eastern Hauts Plateaux region.

The existing centre in Constantine is also slated to receive three new linear accelerators. The first was inaugurated in September 2013, and the remaining two are expected in the first quarter of 2014. Equipment maintenance has proven to be an issue throughout the public health care system, and the ongoing partnership with Varian and Elekta should help to ensure improved maintenance and training. In addition, Boudiaf announced in November 2013 that directorates responsible for monitoring equipment quality and performance and conducting maintenance will be established in major hospitals to reduce service interruptions.

SUPPLY ISSUES & PREVENTION: The health minister, inaugurated in early September 2013, launched a system-wide evaluation of public health institutions that will inform the ministry’s action plan. The minister declared cancer treatment to be one of the primary focuses of this study, along with hospital hygiene and emergency surgical and medical services. Central to this programme are ongoing efforts to coordinate with national education authorities to train the medical personnel necessary to staff the 15 new cancer centres, and to ensure that the required resources are in place to increase early cancer screening.

The state is working to increase the availability of cancer medications, as insufficient local supply is one of the complaints most often levelled in the local press. The prime minister announced in October 2013 that the state would dedicate AD35bn (€322m) to subsidise cancer drugs, particularly chemotherapy medications. However, state officials have also called upon private investors to support this effort in the long term, as demand is expected to rise sharply in the next decade.

Finally, a short-term priority for the ministry is to create a national cancer register to better understand the incidence and trends of non-communicable diseases. A register exists in the Sétif province, but much work remains to be done to replicate the system nationwide.

Increasing the number of qualified medical personnel at all levels through training and partnerships is necessary for these new programmes to be successful. It will take time to build up Algeria’s infrastructure and resources, but the national plan to combat the shifting disease burden has already begun to make progress.