1. Radiation therapy – Delivery in LMIC
Dr Furaha Serventi
Radiation and clinical oncologist
Head of cancer care centre KCMC

2. Introduction
The past decades have seen a progressive increase in the global cancer burden, with two thirds of cancer cases in low and middle income countries
Approximately 50-60% of newly diagnosed cancer patients will need radiotherapy , and 25% of them might receive second course (Owen JB et al, 1997).

3. Africa
Africa includes 51 LMIC and is the region with the largest proportion of LIC (26)
Is the region with lowest access to radiotherapy
Between 1991 and 2010 the number of cases with indication of radiotherapy increased 239% and total number of machines needed is 1,273 and additional 995 Hannah,T.P. et al

4. Total number of linear accelerators – 194
Total number of Co60 – 84
Total number of LINAC in LIC – 7
Total number of Co60 in LIC – 8 ( 53%)
Machines/ million population – 0.26 for whole population and for its LIC

5. Estimate of Radiotherapy machines required in Tanzania
International recommendations mega voltage machines per 1 million population in Low Income Countries like Tanzania
With estimated 50 million people – mega voltage machines are required to provide adequate care

6. Current situation in Tanzania
Ocean Road Cancer Institute (ORCI) – The only cancer centre offering radiotherapy services
The centre is currently equipped with 2 mega voltage (cobalt) machines and 1 Brachytherapy machine- Low dose rate
This is less than 5% of the required number of machines

7. Problem statement Grossly inadequate number of machines
Frequent machine breakdowns as a result of machines working beyond capacity
Frequent delays in changing source – treatment takes longer for every patient

8. Indirect Patients needing to travel long distances to get treated
Lack of free hostel facilities
Unacceptable delays in commencing therapy ( 3-9 months) discourage referrals for short, cost-effective palliative treatments and a lost window period for local control in curative treatments

10. Addressing the needs (Levin CV et al 1999)
Research conducted in 51 countries in Africa observed that better radiation therapy facilities in North and South African countries is because :
concerted political will,
government commitment and
non-governmental organizations' involvement in funding cancer care

11. Tanzania currently has 2 newly established cancer centres
Both these centres have set cooperative efforts through MOUs between local centre, Tanzanian government and international partners to address the inadequacy of radiation services in Tanzania
With RT a capital-intensive form of therapy – these collaborative efforts will serve significantly in sustaining

12. KCMC Cancer care Centre

13. Plan for KCMC
With RT a capital-intensive form of therapy, collaborative efforts with FCCT has made it possible for:
KCMC to develop a proposal for establishing a comprehensive radiation unit
Government to commit itself to providing funds for construction of bunkers
Development of a concrete plan for purchase of radiotherapy machines with cut edge technology

14. Staff allocation One radiation oncologist currently at KCMC
Plans underway to recruit medical doctors and support staff to train in :
radiation oncology
Medical physics
Radiotherapy

15. Conclusion
Setting of a radiation oncology unit is capital intensive both in infrastructure, machinery and staff training
FCCT/KCMC partnership is setting standards and beating all odds to provide access of high quality treatment and cut edge technology for the most vulnerable, most underprivileged in Tanzania

16. At last their cries have been heard! Asante(Thank you)