Simple steps for Building a Sustainable-Cancer Centre in Sub-Saharan Africa.

January 14, 2018 OkonMedPhys  | Tags: Simple steps, Sustainable-Cancer Centre, Simple steps for Building a Sustainable-Cancer Centre, governments of LMIC

The cancer burden in low middle-income countries (LMIC) has led to increased efforts by governments of LMIC to establish cancer care programs especially in the field of radiation therapy.

The cancer burden in low middle-income countries (LMIC) has led to increased efforts by governments of LMIC to establish cancer care programs especially in the field of radiation therapy. To meet up with achieving the 2030 Sustainable Development Goals, they aspire to use the latest state of the art technology in radiation oncology to efficiently and effectively treat the growing number of cancer patients. However, huge investments can’t guarantee adequate radiation oncology services.  The International Atomic Energy Agency (IAEA) and other international organization have great literature on the best approach to establish radiation therapy programs. However, the standard approach may not be applicable in every setting. It is also important to mention here that there is no basis for the narrative that state of the art radiation equipment used in other parts of the world like Europe and the United States for the treatment of cancer can’t be sustainable in Sub-Sahara Africa. Some in the radiation oncology community have been advocating for obsolete technology like the cobalt 60 for teletherapy or special X-ray machines as best suitable because of the social economic and environmental factors affecting the region. Why these narratives when it comes to the healthcare of the people in sub-Saharan Africa? It is not understandable why mobile digital technology, automobile and the most modern technological gadgets function well, but equipment for radiation oncology wouldn’t. The CEO of Elekta Richard Hausmann, one of the two vendors of clinical linear accelerators in his article that featured in the medical design technology magazine, compared cars and cancer radiation therapy. In Sub-Sahara Africa, you will find all the latest models of cars functioning well even with poor roads. So, it is also very possible to have the latest state of the art radiation oncology technology in the region and it will function perfectly well if the right steps are taken. Here are some very simple, very fundamental steps that the governments of these countries can follow in setting up more efficient, scalable and sustainable cancer care center that will be fully operational and with guaranteed sustainability.

A clearly defined and articulated vision. In most parts of Africa, the setting up of cancer care programs is usually done by the government through the Ministry of Health. A fine-tuned, defined and articulated vision is the first stop in building a radiotherapy center with all stakeholders and representatives of professional groups involved. If a country lacks professionals like radiation oncologists or medical physicists, it’s advisable to seek for them in their diaspora. There is always an engaged diaspora that will want to be part of the planning and that would be very advantageous because they can bridge the gap in the transfer of knowledge and technological know-how. The planning team must agree on a vision that is patient-care oriented and satisfactory to all those involved. Such a team can include a Radiation oncologist, Medical physicist, Nurse and Engineer together with government Stakeholders. The numerous services to be offered by the hospital according to the different disciplines must be well defined. The task can’t be left solely for the Minister of Health.

Mobilise support for the vision both at home and from abroad by creating awareness and making the population understand the importance of the project.  The economic and healthcare benefit should be clear to the community. Cancer is a growing global health challenge which validates reasons for not only seeking support from home but also from abroad for the vision. Mobilization of support and creating awareness is usually a very challenging aspect in the African context because government officials fear they might be challenged. This fear comes when there is no clear vision for the project. Once there is a clear, solid and dedicated team behind the vision, there should not be anything to fear for. Let the community be informed, be transparent about the project in any way possible and do not underestimate the role that any stakeholder can play. Mobilising support from the community in diaspora is also important. Of course, all this would mount pressure on the government and create a shift in government budget allocation to deliver on the project. A strategical way of mobilizing support is to set small goals that would eventually lead to the set goals. It is not advisable to start up by saying that you want to build a comprehensive cancer care center, since that requires huge investment and might be difficult convincing the national budgeting board. It would be preferable to take the incremental step approach, breaking the goal into phases. You might first want to start up with one bunker with dependencies as phase 1, then phase 1b a brachytherapy unit might be added, phase 2, the building of a second bunker etc. Following this approach also gives time to train people for the expansion leading to the set goals.

Map out a strategic plan. After mobilizing enough support and of course with an unobstructed vision, it’s time to map out a strategic roadmap plan. In most countries in Sub-Sahara Africa, there is usually a change of government every five years. This is one aspect one has to take into consideration. So, you will want to have a four-year strategic plan that outlines how the radiotherapy center builds up to a successful cancer care center of excellence. Four years roadmap because the fifth year would probably be election year. The plan should also include turning the brain drain equation i.e. attracting the diaspora professionals like Radiation oncologists and Medical physicists, making use of ICTs, implementation of renewable energy. Following the strategic plan strictly would bring in more support nationally and from abroad leading to the participation in research, training and education in global radiation oncology.

Direct purchase link. This is a very important point and should not be neglected. It’s important to make the demand to deal directly with the manufactures of these high-end machines. This shortens the bureaucratic path especially as concerns installation, service contracts, training and maintenance. It also puts pressure on the manufactures to make sure that their products are working in order not to lose other potential customers. Buying and dealing with third parties as concerns these high-end machines has not been positive.

It’s important to put specialized teams in place. If it is possible to get radiation oncologists with different specialization, the better. However, cancer care requires the recruitment of multidisciplinary skills. You will also need a team of Physicists, Nurses, Radiation Therapy Technologists, Engineer etc, key to a successful radiation therapy center is having specialized teams waiting to start work immediately the center is ready to start running. It is very important to understand that radiation therapy involves an interdisciplinary team. This team should include Medical and Radiation oncologists, Medical physicists, Radiation therapy technologists, Social workers, Nutritionists and Nurses.

It is a continuous investment process in advanced technology. The terrain of radiation therapy changes with new therapy techniques and modalities for better patient care. It is also very import to invest in advanced education and training of the staff.

Get involved in clinical trials. After establishing a robust clinical program with a specialized team and advanced technology, hospitals should consider offering clinical trials as a way to increase treatment options for patients.

Get patient feedback. It is very important to always measure the quality of services by getting feedback from patients or their relatives. Any interaction with the patient is a healing interaction and should not be taken for granted. So, the government or leaders should create a system to focus on the patient experience.

Service Continuity. Hold monthly meetings to evaluate the services offered by the centre. 

 Having the above-mentioned steps would be very useful in setting up a radiation oncology program and in guaranteeing its sustainability.