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Strengthening Cancer Care in the Democratic Republic of the Congo: Experts Recommend Decentralizing Services


The imPACT Review covered 21 facilities in the DRC including Monkole Hospital (pictured), a private hospital in Kinshasa. (Photo: Dr Teddy Mukendi, Monkole Hospital, DRC)

Decentralizing cancer diagnosis and treatment capabilities would provide more people in provinces across the Democratic Republic of the Congo (DRC) with better access to cancer care, a team of international experts concluded following a six-month imPACT Review requested by the DRC’s Ministry of Health.

The team, brought together by the IAEA, the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), carried out virtual interviews with staff from 21 facilities across the Kinshasa, Tshopo, Haut Katanga and South Kivu provinces.

The DRC faces challenges in delivering services to diagnose and treat cancer patients across its vast territory. Most diagnostic and treatment services are available in private facilities in Kinshasa, and considerable disparity exists in access to diagnostic services across the country. Only one private radiotherapy facility in the country of approximately 90 million people provides radiotherapy, and while Government facilities generally have advanced capacities in pathology, they have only limited medical imaging and biology services. In Africa, more than 20 countries have no radiotherapy treatment unit.

The most prominent types of cancer in the DRC are prostate cancer in men with around 7 471 new cases annually, and cervical cancer in women with around 7 772 new cases per year, according to online cancer statistics database GLOBOCAN. 

“The DRC is facing an epidemiological transition, with an increase in incidence and mortality from cancer,” said Dieudonné Mwanba, Director of the General Directorate for Disease Control, Ministry of Health. “Diagnosis of these diseases often comes late and care is still very limited. Training medical staff involved in cancer management is key, and we need to set up diagnostic and treatment centres in urban areas for the most frequent cancers.”

imPACT Review recommendations

Assessing the DRC’s cancer control needs and capacities, the experts noted the importance of training staff in all areas of cancer control, and of strengthening the capacity of the National Centre for the Fight against Cancer, the country’s main coordination body set up in 2020. Cancer surgery, for example, is currently performed by general surgeons and other specialists without dedicated training on oncology.

The Review team recommended a more frequent, cost-effective use of the private radiotherapy facility established in 2020 and which treated 130 patients in its first year. The facility has the capacity to treat 500 patients annually, and the creation of an agreement between the Ministry of Health and the facility could optimize the use of the radiotherapy unit, they advised.

The experts also suggested making radiotherapy progressively available in the provinces through infrastructure, education and training, and related necessary financing, to ensure that the more than 25 000 patients requiring treatment each year could be treated. Across the country, maintenance of machines and medical equipment would be crucial to ensure delivery of care to patients, they noted.

“Cancer is a major public health problem in our country,” said Pacifique Misingi Aye, Director of the National Centre for Blood Transfusion in Kinshasa. “We need to prioritize prevention and early detection to minimize the need for care at advanced stages in poorer populations that are the most affected.”

An integrated approach to cancer control, including the development of a National Cancer Control Plan (NCCP) would be critical, advised the experts. A NCCP includes areas such as prevention in terms of, for example, vaccination campaigns against the Human Papilloma Virus (HPV), and treatment in terms of setting out pathways to improve the quality and quantity of training available to surgeons. In the DRC, the experts noted, cancer is often treated through surgery because radiotherapy and chemotherapy services are not sufficiently developed, and diagnostic services are limited.

“Saving lives requires the engagement of all relevant parties, from local to international levels,” said Sambou Bacary, the WHO’s Head of Disease Control Cluster. “The government is encouraged to elaborate the development of its NCCP. The UN organizations will continue to provide support along the way,” he added.

The emergency entrance of the Monkole private hospital in Kinshasa, DRC. (Photo: Dr Teddy Mukendi, Monkole Hospital, DRC)

IAEA support in radiation medicine and radiation safety

The imPACT review provides the DRC with short, medium and long term recommendations covering topics such as the development of a population-based cancer registry, early detection of cervical, breast, colorectal and prostate cancers, palliative care and radiation protection.

The review is part of the broader ongoing technical cooperation support provided by the IAEA in the areas of radiation medicine and radiation safety. A new project will focus on establishing a multi-diagnostic and radiotherapy centre to provide the country with an integrated medical facility dedicated to health care (diagnosis and therapy), education and training, and research to contribute to the reduction of cancer mortality.

On World Cancer Day on 4 February 2022, Félix-Antoine Tshisekedi Tshilombo, President of the DRC and Chairperson of the African Union, co-hosted the launch of Rays of Hope, the IAEA’s initiative to bridge the global cancer care gap in low- and middle-income countries, jointly with Senegal’s President Macky Sall, incoming Chairperson of the African Union. imPACT Review recommendations offer important input to the Rays of Hope initiative, as they help define the support packages for recipient countries such as the DRC.

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