Ige T, Lewis P, Shelley C, Pistenmaa D, Coleman CN, Aggarwal A, Dosanjh M, Zergoug I, Eduardo HM, Bvochora-Nsingo M, Fulu K, Ralefala T, Grover S, Maison-Mayeh AM, Ndi SR, Attalla E, Deiab N, Belay EY, Acquah GF, Amankwaa-Frempong E, Foy H, Ngigi E, Badi F, Elburi I, Harivony T, Kone A, Maiga S, Tolba A, Mootoosamy S, El-Boutayeb S, Momade A, Midzi W, Grobler M, Aruah SC, Kra J, Diagne M, Trauernicht C, Elbashir F, Ali NAE, Makwani H, Yusufu S, Farhat L, Mounir B, Awusi K, Azangwe G. Understanding the challenges of delivering radiotherapy in low- and middle-income countries in Africa.
J Cancer Policy 2023;
35:100372. [PMID:
36512899 DOI:
10.1016/j.jcpo.2022.100372]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND
Access to high quality radiotherapy (RT) continues to be a major issue across Africa with Africa having just 34% of its optimal capacity.
METHODS
We co-developed a survey with clinical, academic and policy stakeholders designed to provide a structured assessment of the barriers and enablers to RT capacity building in Africa. The survey covered nine key themes including funding, procurement, education and training. The survey was sent to RT professionals in 28 countries and the responses underwent qualitative and quantitative assessment.
RESULTS
We received completed questionnaires from 26 African countries. Funding was considered a major issue, specifically the lack of a ring fenced funds from the Ministry of Health for radiotherapy and the consistency of revenue streams which relates to a lack of prioritisation for RT. In addition to a significant shortfall in RT workforce disciplines, there is a general lack of formal education and training programmes. 13/26 countries reported having some IAEA support for RT for education and training. Solutions identified to improve access to RT include a) increasing public awareness of its essential role in cancer treatment; b) encouraging governments to simplify procurement and provide adequate funding for equipment; c) increasing training opportunities for all radiotherapy disciplines and d) incentivizing staff retention.
CONCLUSION
This survey provides unique information on challenges to delivering and expanding radiotherapy services in Africa. The reasons are heterogonous across countries but one key recommendation would be for national Cancer Control plans to directly consider radiotherapy and specifically issues of funding, equipment procurement, servicing and training.
POLICY SUMMARY
The study demonstrates the importance of mixed methods research to inform policy and overcome barriers to radiotherapy capacity and capability in LMICs.
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