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Representatives of African Member States Work to Create More Sustainable Radiotherapy Services

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The delegation from Madagascar working with the IAEA to develop a workplan for sustainable radiotherapy services. (Photo: J. Howlett/IAEA)

Representatives from seven African countries discussed the planning and delivery of sustainable radiotherapy services at a meeting at the IAEA earlier this month. Topics covered included technical and procedural advice for workforce development, planning and procurement of appropriate infrastructure and equipment, as well as safety and security considerations for radiotherapy services.

“Our goal is to strengthen IAEA Member States’ capacity to ensure radiotherapy facilities remain operational to treat a high number of cancer patients in an effective, safe and sustainable manner,” said Dazhu Yang, IAEA Deputy Director General and Head of the Department of Technical Cooperation.

Each delegation consisted of a ministry of health policy coordinator, leading radiation oncologist, procurement planning officer and a representative from the national nuclear safety regulator.

“Each country has its own challenges in addressing cancer,” said Shashi Sewsurn, Head of Radiation and Clinical Oncology at the Victoria Hospital in Mauritius. “Through the collective wisdom at this meeting from a diverse range of cancer and regulatory professionals, we have shared how we have approached programmes and activities in different ways and offered new insights and solutions which can be adapted for our individual needs and our situation. One helpful tool is IAEA’s imPACT Review of our cancer control capacities, which is scheduled for December. We look to its findings to assess whether we are on the right track with the development of our new comprehensive cancer centre,” she said.

Keeping the systems going

A major challenge highlighted throughout the meeting was the need to continuously build and maintain the knowledge of the medical workforce to meet rising demands and keep up with technological advances.

“We want to be able to provide all of our cancer patients with access to the most appropriate equipment possible,” said Radiation Oncologist Papa Macoumba Gaye, Head Manager of Radiotherapy Services at the Dalal Jamm Hospital in Senegal. “But this also means we have to meet the huge challenge to find additional medical personnel and improve the skills of our existing staff to be able to operate this equipment safely and effectively.”

Kennedy Lishimpi, Director for Cancer Control at Zambia’s Ministry of Health, highlighted how his country has found a way to overcome their staffing shortfall, “We have established the Levy Mwanawasa University, which is managed by the Ministry of Health, specifically so that we can double or hopefully triple our staff numbers by 2020.”

Getting it right from the start

“Procuring technical medical equipment for radiation imaging is highly specialised and not something a country does every day,” said Jackson Orem, Head of Uganda’s Cancer Institute. “We need to understand what are the recognised standards and processes so that we be reassured that we have followed the correct procedures and avoid mistakes.”

David Beine Atuwo, Director of the National Cancer Control Programme in Nigeria, highlighted the importance of the safe and secure handling of radioactive sources used in medicine. “The transportation and stewardship of this lifesaving material is probably the weakest link in the chain in many countries. Applying government policy and ensuring their coordination in advance is crucial in facilitating the straightforward movement and installation of radioactive sources.”

Delegations from seven African Member States came to Vienna to discuss ways forward for sustainable radiotherapy services. (Photo: J. Howlett/IAEA)

The long-term view

Malala Razakanaivo, Radiation Oncologist at the Joseph Ravoahangy Andrianavalona University Hospital in Madagascar, outlined why their radiotherapy services need to be sustainable. “In the next ten years we are expecting to see a rise in the need for cancer care. 60% of our current patients already require radiotherapy. We expect to see a great deal more patients with advanced stages of cancer when we begin our screening programmes for cervical and breast cancers,” he said. “This is why we are planning a new public cancer centre to prepare for this potentiality. The meeting this week has helped give us a clear vision of how to build long-term thinking into all aspects of our work in cancer control.”

Partnerships including with the Private Sector and political commitment at the highest level are essential to ensure access to sustainable quality services. In Kenya, the involvement of the President was key in including cancer services in Universal Health Coverage, reducing cancer treatment waiting times from 15 to 2 months stressed Alfred Karagu, Director of Kenya’s National Cancer Institute.

In concluding the meeting, speakers emphasized that a shift in thinking and culture at government level is needed to make certain that radiotherapy services can be sustainable. With the tools and workplans developed by the delegations at the meeting, solid cases to prioritise radiotherapy can be brought to national decisionmakers.

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