Tanzania: Improving Cancer Treatment with More Health Professionals and Better Facilities

What were the main challenges in the fight against cancer in Tanzania?

Dr. Alain Fourquet: Firstly, Tanzania faces significant challenges in terms of screening, particularly in rural areas. For instance, it was estimated in 2019 that only one-third of cancer cases was being treated. This is due to limited access to screening centers, a lack of equipment in cancer care facilities, and a lack of awareness of early detection techniques. There is also a lack of knowledge about cancer, and a number of stereotypes. The few people who have heard a bit about it, often tend to think it’s a female disease.

Next, when a case is detected, it is crucial that appropriate treatment is accessible. However, before the project, there were only seven external radiotherapy machines in a country of 61 million. That’s compared to 607 in France, for roughly the same population. Furthermore, treatment centers sometimes only have outdated machines or do not have a surgery unit for comprehensive patient care.

Yet, the number of cancer cases in Tanzania is constantly increasing, and it is expected that this will become a real public health problem in the coming years.

Further reading: Zanzibar's State of the Art Health Clinic

How did the TCCP project begin?

We started from the observation, with the Aga Khan and the AFD, that it was necessary to adopt an integrated approach to tackle these challenges, combining awareness, screening, and strengthening treatment capacities. We therefore proposed a 4-year pilot action plan in the two main regions of the country: Dar es Salaam and Mwanza.

The project saw the launch of awareness campaigns across the media and social networks, along with strengthened screening actions throughout the country. We have trained more than 460 doctors and health professionals in public and private non-profit institutions. The project benefited from the extensive and structured network of the Aga Khan, which has health centers throughout the country.

The project also enabled investments in radiotherapy equipment, with the creation of a cancer treatment center within the Aga Khan Hospital in Dar es Salaam. It has been equipped with two modern radiotherapy machines and a dedicated scanner for treatment preparation, and will include an outpatient chemotherapy unit. As part of this agreement, 30% of patients must be covered by the national health insurance system or receive free care if they cannot afford it. Imaging equipment has been installed in the public hospitals of Dar es Salaam and Mwanza.

Finally, the project relied on the involvement of various actors to ensure its sustainability. First, patient associations that were trained to support new patients. Then, 400 community health workers were set up within the communities themselves to raise awareness and encourage members to get screened. Most important, the Tanzanian government was involved at every stage of the project.

Four years on, what assessment do you make of this project?

So far, more than 750,000 people have been screened thanks to this project, with innovative approaches improving diagnoses. For example, a dual Covid-cancer screening was set up for men, with antigen tests rather than prostate exams to overcome screening barriers. "Screening trucks" were able to reach remote villages in the two regions. The awareness campaigns have reached more than 4.5 million people.

On the other hand, the number of new cases in partner hospitals has increased, and notably the number of early cases has doubled, showing that the method has been effective and has allowed for better management of patients.

Finally, not only has the project worked well, but it is above all exportable across the entire country. We now hope to maintain the momentum and ensure that efforts continue, notably via a national action plan in partnership with the government.