A former health minister who has now been appointed to spearhead the National Cancer Plan speaks out about what has been keeping him busy and the importance of making the paradigm shift from ‘treatment’-orientated healthcare to prevention and early screening.
Could you briefly introduce yourself?
I was born in 1940 and studied medicine with a specialty in general surgery. In parallel to my career as a doctor in the public sector, I also had an administrative and political career. I was twice Dean of the Faculty of Medicine of Algiers and for a very short time Minister of Health in 1988. Today, I am responsible for the Anti- Cancer Plan, which has three phases. The first is to do a very broad survey across the country, the second is to develop recommendations based on this survey; and the third phase, in which we are right now, is the validation of the plan by all stakeholders.
As a former Minister of Health, how do you assess the current Algerian healthcare system ?
I can evaluate it only by analyzing its evolution. In Algeria, fifty years ago, there were 300 physicians, today there are 60,000, 90 % of the population had no access to basic health care, today 95% of the population has access to it. According to a study, Algerian citizens do not take more than 15 minutes to get to a pharmacy. To summarize, what characterizes the health care system in Algeria today is its accessibility.
Moreover, since 1962, the budget of the Ministry of Health has continuously increased– as a consequence infrastructures, equipments and staff have grown too; legal and administrative texts were brought in line with changes in the country. To give a concrete example: there are seven anti- cancer centers, seven are under construction and we hope to open seven more by the end of this Anti-Cancer Plan. The quantitative assessment of the Algerian health system and the qualitative assessment are very positive: life expectancy increased from 50 years in 1962 to 77 years today, the number of inhabitants rose from 10 million in 1962 to 40 million today; and we achieved our epidemiological transition.
Our challenge is twofold: firstly we need to adapt our healthcare system to the new conditions, ie older patients, new technologies, innovative training, changing attitudes etc. On the other hand, we must refocus the debate and the investments for prevention and early diagnosis, which constitutes a genuine information and awareness policy for the whole society.
How would you describe your experience as Minister of Health?
Between 1988 and today, times have changed dramatically. In 1988, the debt of Algeria was very important, the country was experiencing political unrest, but the challenges in the field of Health were easier than today, and the founding texts of the Algerian healthcare system were still valid and relevant. The task was more exciting: we had to fight against communicable diseases and the results were observed quickly. Today, resources are more important, but the challenges are more complex, they affect all areas – economic, social, ethical, etc…and Algerians became more demanding.
What is your assessment of the policy of the current Minister of Health?
Algeria has engaged in several areas of reform, including Health and Education. We have been talking about healthcare reform in Algeria for years now. They have not been implemented because of various hurdles: bureaucracy, centralization, lack of actors and users accountability etc. We must first work on these areas and then set about implementing healthcare reform. The key is to instil acceptance of change and include all stakeholders in the reform process, even if this takes time.
You are responsible for the current Anti- Cancer Plan. What importance do you give to awareness?
We have eight main goals, two of them are very important to me: primary prevention and secondary prevention- which is screening. We do not know the exact causes of cancer, but everyone agrees that there are risk factors such as tobacco, for example. This long-term prevention must be done now: we want to educate the whole civil society, particularly children, who start smoking at 10-12 years and become real smokers from 16!
For screening, I would take the example of breast cancer: Algeria’s breast cancer prevalence has been increasing dramatically for the last 10 years; about 11,000 new cases are discovered each year. So far, testing has not been organized: the Ministry of Health has four testing centers, others have emerged through specific initiatives, but none of them involves a national policy. Thus, our goal is to organize and unify the screening and to evaluate our strategy by independent experts, and eventually to constantly adapt our structures to the results of the evaluation. I will not elaborate on this aspect, but be aware that the data collection and processing on which decisions are based, is a real challenge in Algeria!
The current National Anti- Cancer Plan comes to an end in 2019. What would you like to have done by that date?
The National Anti- Cancer Plan is very ambitious, realistic and achievable. I hope we would have met the eight goals that we have set, and especially the two I mentioned above. I am also proud of our training programs for staff related to the healthcare system: physicians, paramedics, managers etc. Even though I know that training in Algeria is already very efficient, since we export doctors.
Eventually, we should improve the human care of our patients. Cancer is certainly not the disease that kills the most, but it is one that causes the most distress. Palliative care and continuous psychological support are just some of the tools we can use in this context. The goal is that cancer patients manage their disease, in the same way as diabetes patients do.
Algeria is not a violent country. Algeria is a modern country, which is now the largest country in area of Africa, it is an attractive place, which looks to the future. This does not mean that everything is rosy, and that the difficulties are non-existent, but we learned from the past in order to move forward healthily.
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