COVID-19 is continuing to have far-reaching impacts around the world, including on small-scale fishing communities. This study details the findings from 39 in-depth interviews with community members, community leaders, and fish traders in five communities in Kenya about their experiences since the beginning of the COVID-19 pandemic in March, 2020. The interviews were conducted by mobile phone between late August and early October 2020. In each community, people were impacted by curfews, rules about gathering, closed travel routes, and bans on certain activities. Fish trade and fisheries livelihoods were greatly disrupted. Respondents from all communities emphasized how COVID-19 had disrupted relationships between fishers, traders, and customers; changed market demand; and ultimately made fishing and fish trading livelihoods very difficult to sustain. While COVID-19 impacted different groups in the communities-i.e., fishers, female fish traders, and male fish traders-all experienced a loss of income and livelihoods, reduced cash flow, declining food security, and impacts on wellbeing. As such, although small-scale fisheries can act as a crucial safety net in times of stress, the extent of COVID-19 disruptions to alternative and informal livelihoods stemmed cash flow across communities, and meant that fishing was unable to fulfil a safety net function as it may have done during past disruptions. As the pandemic continues to unfold, ensuring that COVID-19 safe policies and protocols support continued fishing or diversification into other informal livelihoods, and that COVID-19 support reaches the most vulnerable, will be critical in safeguarding the wellbeing of families in these coastal communities.
Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g., age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance (personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival rates vary considerably as a function of geography, opportunity, wealth and development. Quality of life is impacted similarly, such that aspects of care related to coordination and integration of care across primary, community and specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer; and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-income resource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer care and treatment through three plenary presentations and five interactive workshop discussions: 1) establishing, implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community, and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4) issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. A number of recommendations were proposed relating to capacity-building (standards and guidelines, protocols, new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping and analysis of variations in primary, community and specialist care across countries with identification of models for effective, integrated clinical practice; the importance of considering the introduction, or expansion, of evidence-supported clinical practices from the perspectives of health economic impact, the value for health resources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom control and integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy.