Improving Access to Radiation Medicine in West Africa – A Roadmap for Peaceful Applications of Nuclear Technology
This report sheds light on the pressing issue of limited access to radiation medicine in West Africa, emphasizing the peaceful applications of nuclear technology. Insights from symposium hosted under the Sustained Dialogue on Peaceful Uses of nuclear science and technology (SDPU), titled “Improving Access to Radiation Medicine in West Africa”, held in Ghana in July 2023, highlight the challenges faced by the region. These include inadequate equipment maintenance, workflow inefficiencies, and a lack of public education. Addressing these disparities not only has health implications but also holds significant economic and social ramifications, potentially spurring innovation, international collaborations, and economic growth. Recommendations from the symposium converge on several key areas: the necessity for regional guidelines on equipment procurement and robust maintenance; the call for initiation of standardized assessments of radiotherapy patient care, infused with Key Performance Indicators; and the benefits of amplification of radiation medicine awareness by engaging local communities, policymakers, and media. The SDPU-hosted engagement aimed to promote early cancer detection and increase awareness about radiation medicine by building dialogue between expert communities on addressing these challenging areas. By capitalizing on collective expertise and resources, the SDPU seeks to identify areas of new cooperation with significant potential to advance healthcare quality in the region. Solving the problem of unequal access to cancer care in the region will require unwavering commitment from governments, international organizations, healthcare establishments, and other pertinent stakeholders. SDPU aims to engage a broader group of experts to promote support for large-scale changes. With united efforts, the aspiration for a healthier, more resilient West Africa, with comprehensive cancer care and in alignment with the United Nations Sustainable Development Goals, is within reach, promising a brighter future for its communities.
Keywords: Radiation Medicine, Nuclear Medicine, Oncology, West Africa, Global Health Partnerships, Nuclear Technology, Peaceful Uses, Healthcare Access, UN Sustainable Development Goals, SDG3 – Good Health and Well-Being
Introduction
This report reflects the collective efforts of a distinguished group of experts, policymakers, healthcare professionals, patient advocates, and other stakeholders to identify key challenges and opportunities to improve access to radiation medicine. These stakeholders gathered in Ghana for the SDPU symposium on Improving Access to Radiation Medicine in West Africa in July 2023. With a focus on addressing the critical issue of limited access to radiation medicine in the region, the symposium provided an invaluable platform for insightful dialogue, an enriching exchange of experiences and knowledge, and proposed collaborative initiatives aimed at transforming the landscape of radiation therapy in West Africa.
Building upon the SDPU initiative, which seeks to promote the peaceful applications of nuclear technologies and identify opportunities for their use, this symposium was made possible through the joint efforts of the US Civilian Research & Development Foundation (CRDF Global), the Ghana Ministry of Health, the International Atomic Energy Agency (IAEA) and other stakeholders in the medical field. The wider SDPU program is jointly funded by the US Department of State and the UK Department for Energy Security and Net Zero.
It is widely recognized, as noted by symposium stakeholders, that radiation therapy is crucial in cancer diagnosis, treatment, and management, offering a proven and effective approach for both curative and palliative care. However, the region faces numerous challenges that hinder the availability and accessibility of radiation medicine services. Enhancing access to radiation medicine in West Africa is of paramount importance for several compelling reasons. The symposium concentrated on three pivotal areas: equipment maintenance, improving workflow and patient experience, and public education and outreach. By focusing on proper equipment maintenance, streamlined workflows, and enhanced patient experiences, the region can achieve more efficient and effective treatments, thereby positively impacting survival rates and improving the quality of life for cancer patients and those requiring radiation therapy.
Building on these priorities, the virtual workshop leading up to the Ghana symposium highlighted three pivotal areas that resonate deeply within the broader context of radiation medicine in West Africa. First and foremost, equipment maintenance is more than just a functional necessity—it represents the bedrock of reliable and trustworthy care. Prioritizing robust maintenance contracts, availability of spare parts, and accessible engineer support is vital as they can effectively reduce the chances of care interruptions, and agile management of high-risk elements offers protection against potential holdups.
Streamlined workflows, the second focal point, are indicative of the pinnacle of healthcare efficiency. Utilizing cutting-edge solutions, such as intelligent automation systems and telemedicine platforms, allows hospitals to fine-tune their operational frameworks, ensuring that care is both timely and aptly tailored to patients’ needs. These efficiencies ultimately increase access to radiation medicine by optimizing operational processes.
Furthermore, the symposium discussion accentuated the importance of enhanced patient experiences, emphasizing that the care journey extends beyond mere clinical procedures. It is underpinned by the broader awareness and advocacy efforts of the healthcare community. Endorsing education and outreach, assimilating every aspect of the healthcare continuum, and ensuring access to top-tier diagnostic tools like medical imaging encapsulate a holistic view of patient requirements, thereby bridging the gap between awareness and vital interventions.
Given these considerations, the focal areas collectively suggest ways to improve access to radiation medicine in the region. Each area has its importance, and when combined, they present a constructive direction for West Africa: a region aiming to provide radiation medicine with precision and intent. This could potentially lead to better survival outcomes and improved patient well-being. Efforts in these areas might also support the building of healthcare systems that are better equipped to handle the increasing prevalence of non-communicable diseases. Furthermore, stakeholders noted that it is crucial to confront the prevailing disparities in access to radiation medicine, shedding light on the inequalities where access is predominantly skewed towards high-income patients in urban areas and the more developed regions across West African countries. By openly acknowledging and addressing these glaring discrepancies, society can lay the foundation for substantial improvements in healthcare equality within the region. Radiation medicine, a cornerstone of comprehensive cancer care, must become accessible across the spectrum, ensuring that individuals from all walks of life regardless of their socioeconomic status or geographic location have equitable opportunities for treatment. This transformative step not only promises improved overall health outcomes but also constitutes a significant stride towards fulfilling the United Nations’ Sustainable Development Goals (UN SDGs) pertaining to health and well-being.
Lastly, stakeholders opined that enhancing access to radiation medicine has far-reaching economic and social impacts in West African countries. Governments investing in radiation medicine infrastructure and improving cancer care facilities can attract international partnerships and research collaborations, stimulating economic growth and fostering innovation in the healthcare sector. These benefits extend beyond individual well-being and positively impact the region’s economic development, elevating its global standing.
The overarching objective of this report is to document and promote the practical recommendations developed by experts at the SDPU symposium on “Enhancing Access to Radiation Medicine in West Africa.” Under the SDPU, we will use these outcomes to further foster collaboration among governments, international organizations, and additional stakeholders to tackle challenges that impede access to radiation medicine in West Africa. The focus of the SDPU initiative will also extend beyond the immediate scope of access to radiation medicine to encompass the broader mission of the SDPU. Through an integrated approach, the SDPU initiative aims to support new or existing efforts, fostering a robust and inclusive healthcare ecosystem. This support contributes to the sustainable development of systems that support health and well-being in West Africa and beyond.
Main Challenges
Inadequate Equipment Maintenance
Stakeholders of the symposium highlighted that one of the primary challenges faced by West African countries is the lack of proper equipment maintenance in radiation medicine facilities. This issue is compounded by multiple factors, including a shortage of skilled medical engineers and technical personnel, inadequate maintenance contracts, limited funding for repairs and upgrades, and inconsistent supply chains for spare parts. As a result, critical medical equipment often experiences frequent breakdowns, leading to extended downtime and compromising patient outcomes. Addressing this persistent challenge is essential not only to improve patient care and trust but also to optimize the utilization of valuable financial and human resources.
Workflow and Patient Experience
During the symposium, participants highlighted that radiation therapy treatment programs in the region suffer from inefficiencies and fragmented healthcare systems, resulting in extended waiting times for patients, treatment bottlenecks, and increased healthcare costs. The lack of streamlined workflows or patient-centric approaches can contribute to heightened anxiety and fear among patients, in addition to substantial out-of-pocket treatment expenses. It was also pointed out that limited access to radiation medicine in West Africa due to cost barriers, long distances to treatment centers, and lack of supporting facilities for patients further exacerbates this issue. Prioritizing the revamp of workflows and focusing on patient well-being are vital steps in delivering timely, affordable, and effective radiation therapy services.
Insufficient Public Education and Outreach
Participants at the symposium underscored the prevailing challenge of a limited awareness among the public and healthcare workers about the benefits, availability, and safety of radiation medicine. Misconceptions and myths surrounding radiation therapy have led to hesitancy in seeking treatment and contribute to late-stage diagnoses. Additionally, further efforts can be made to educate healthcare workers, traditional healers, and communities about the availability of radiation medicine and its potential to save lives, particularly in rural areas. To address this issue, participants expressed the importance of implementing comprehensive public education and outreach programs becoming crucial. By dispelling myths and improving early detection rates, these initiatives can empower individuals to make informed healthcare decisions, fostering trust in medical interventions within the communities.
Accessibility and affordability of radiation therapy and medical imaging are essential, considering the challenges patients face in reaching hospitals. Addressing this issue requires the development of comprehensive support systems for patients in rural areas. Strengthening referral systems, including both forward and backward referrals, and by institutionalizing outreach services with visiting specialists at the primary care level, early detection, diagnosis, and management of diseases can be significantly enhanced. Experts discussed an interest in further conferring on options and case studies for facilitating rural patients’ access to radiotherapy facilities and options for minimizing the costs and time required for travel to these facilities.
During the discussions, participants underscored the pressing need to increase government and policymaker support and understanding of the value of radiation medicine. Communicating the urgency of infrastructure funding for radiation medicine is essential. Without adequate support, even the best education initiatives may not reach their full potential. By engaging with policymakers, stakeholders can ensure the message of radiation medicine’s benefits reaches those shaping healthcare policies. Stakeholders consistently voiced the sentiment that a multifaceted approach, combining education, awareness, and policy advocacy, is key to overcoming misconceptions and improving healthcare outcomes in the region.
Opportunities
Capacity Building
Throughout the discussions, symposium participants emphasized the potential advantages of leveraging the expertise of medical engineers, radiation therapists, and radiation oncologists to foster collaboration with local, regional, and international organizations. Forging partnerships with experienced institutions is essential. Such collaborations facilitate knowledge exchange and skill development opportunities. This enhances the overall capabilities of the local workforce. It also opens doors to resource sharing opportunities, leading to cost-effective solutions. These partnerships can drive innovation in equipment maintenance and patient care.
However, as the region embraces greater collaboration, participants noted the negative effect of the loss of engineers and technicians to other more prosperous and developed institutions and countries, otherwise known as brain drain. With increased exposure to regional and international networks, there is a possibility that highly skilled professionals could be drawn away from the region in pursuit of better prospects abroad. To mitigate this risk, local authorities and institutions must create an environment that promotes collaboration. They should also offer competitive incentives and professional growth pathways. By fostering a strong sense of belonging, providing access to cutting-edge research projects, delegating administrative tasks to radiation therapists, and offering recognition for contributions, the region can strike a balance between collaboration and retaining its valuable talent pool. This way, the benefits of regional and international partnerships can be harnessed while safeguarding against the unintended consequence of brain drain. Participants also noted the need to continually train new engineers and technicians to ensure a steady supply of new manpower to operate and maintain equipment associated with radiation medicine.
Technology Advancements
Throughout the discussions, contributors to the symposium embraced cutting-edge technologies such as telemedicine, rural medicine, artificial intelligence (AI), and digital health solutions that can revolutionize radiation medicine services in West African countries. Telemedicine, consultations, treatment planning, and follow-up care conducted remotely can reduce the strain on major urban centers and expand access to underserved rural populations. There was also a consensus on the value of digital health platforms in streamlining data management, treatment monitoring, and knowledge sharing among healthcare professionals. The integration of AI and digital health solutions can lead to reduced waiting times for patients seeking radiation medicine diagnostic and treatment services, ultimately enhancing the overall patient experience.
Public-Private Partnerships
Throughout the dialogue, stakeholders consistently emphasized the importance of public-private partnerships as a viable strategy to overcome resource limitations and bolster radiation medicine infrastructure. These stakeholders expressed that active collaboration with private healthcare providers, medical equipment vendors, and non-governmental organizations (NGOs) can facilitate resource-sharing and financial support, ultimately leading to sustainable improvements in radiation medicine accessibility. These partnerships bring together expertise, resources, and innovation, enabling effective solutions for complex healthcare challenges. Long-term contracts, spanning 10 years or more, can be established to maintain profitability for the private sector while keeping services affordable for patients. Such partnerships would also help distribute the financial burden of costly radiation medicine equipment and mitigate risks for the public sector.
Assessments
To advance radiation medicine in West African countries, robust assessment endeavors are crucial. Governments and relevant stakeholders must invest in gap analysis and assessment projects and support initiatives that address critical aspects of the healthcare system.
Standardized assessments of radiation therapy facilities, equipment and resources across the region provide valuable insights into existing infrastructure, identify gaps, and allow for the formulation of targeted improvement strategies. By adopting and tracking key performance indicators (KPIs), decision-makers can evaluate the efficacy and impact of radiation therapy services continuously. Assessments that define and measure KPIs also enable healthcare systems to enhance the quality of cancer care continually.
Addressing gaps in the radiation therapy workforce is another vital aspect. Identifying issues related to working conditions and workforce retention through in-depth assessments will enable the development of strategies to attract and retain skilled professionals. Building a sustainable and equitable cancer care ecosystem through such assessments will ultimately lead to improved patient outcomes and a healthier future for the region.
Recommendations
Based on the identified challenges and opportunities and informed by an exchange of experiences and constructive dialogue at the symposium, the following recommendations are proposed.
Develop Regional Guidelines for Equipment Procurement and Maintenance
To enhance the maintenance of radiation medicine equipment, specialized guidelines should be established, encompassing standardized procurement templates and detailed maintenance contracts with ‘Right to Repair’ clauses. These guidelines should also include education and awareness programs about the procurement process, emphasizing the importance of liquidated damages to ensure vendor accountability. Furthermore, developing a ground-up approach with local teams is vital for sustainable operations. Collaborations with entities like IAEA and World Health Organization are vital for effective guideline creation, and a sustainable engineering ecosystem requires partnerships with local educational institutions, emphasizing comprehensive training and the development of local talent. Emphasizing robust equipment management can optimize equipment longevity and functionality.
For improved radiation medicine access in West Africa, regional working groups should be created to manage equipment parts, vet vendors, and train engineers. In this effort, addressing extended downtime is critical, with a need to define specific service level agreement (SLA) expectations for maintenance and repairs. Maintenance contracts need to be precise, adaptable, and governed efficiently, emphasizing time management, regular training, and prompt service. The inclusion of financial penalties assures vendor accountability and adherence to SLA terms, thus minimizing the likelihood of extended downtime that can significantly impact patient care.
Streamlined radiation medicine operations demand strong governance, including rapid customs processes for radiotherapy parts, specialized courier services, government backing for overseas engineers, and a unified patient-centric approach with vendors. Encouraging vendors to share regional infrastructure is also essential.
Strengthen Radioisotopes Logistics
Prioritizing timely access to equipment spare parts is essential for maintaining radiation equipment, reducing delays, and supporting continuous patient care. An efficient procurement process, including the identification, cataloging, and management of spare parts, ensures quick machinery repairs and operational efficiency. Emphasis on sourcing reliable spare parts and forecasting demand for frequently malfunctioning components ensures preemptive availability. Strategic partnerships for bulk acquisitions and enduring contracts, along with effective customs liaisons, can streamline clearance and advocate for favorable tariffs, leading to cost savings. Collaborative efforts among regional radiotherapy vendors to establish a shared resource network will further enhance cost-effectiveness and problem-solving capabilities, fortifying the healthcare infrastructure in West Africa against future challenges.
Develop and Pilot Standardized Assessments for Radiation Medicine in West Africa
Prioritizing the development and piloting of standardized assessments tailored for radiation medicine can also improve access in West Africa. These assessments, integrated with KPIs, aim to illuminate potential gaps, possibly enabling more informed interventions.
Additionally, an exploration into workforce conditions could highlight areas for enhancement, potentially leading to improved retention and satisfaction rates. Collaboration with stakeholders is advisable to ensure their feedback on the assessments while taking into account the insights of clinicians, technicians, and engineers. Stakeholders’ feedback could also be a key part of the training initiatives, ensuring that as clinical practices evolve and care pathways are reviewed, staff are not only trained but also feel valued and see a clear trajectory for their professional advancement within the region.
On the fronts of quality and safety, there is a suggestion to consider standardizing clinical processes and endorsing protocols that might encourage operational uniformity and efficiency. This initiative should be reinforced by training sessions, aiming for adherence to proposed standardized protocols. As practices evolve, periodic reviews and adjustments of care pathways might be beneficial, offering training as necessary and addressing radiation medicine necessities when possible.
Operational excellence could be pursued through the potential streamlining of workflows and optimal resource utilization, paired with a possible shift to electronic workflows from traditional paper-based systems. To support these initiatives, establishing a system for the meticulous tracking of operation statistics is recommended, ensuring a data-rich environment for informed decision-making. Enhancing the quality of this data is also crucial, as robust, dependable data are the foundation for gauging progress and pinpointing areas requiring focus. Regular audits and updates to the data management systems should be conducted to uphold data integrity, which is a cornerstone of operational excellence.
The connection between operational metrics and patient experience is vital; improved data insights directly contribute to better patient care. Hence, elevating the patient’s experience is a primary consideration. It is recommended to establish a local patient experience team responsible for developing and executing an operational improvement action plan. This plan would include mapping patient journeys, examining wait times, and communication efficacy, and implementing regular patient satisfaction assessments. These initiatives will serve as mechanisms for ongoing service refinement and enhancement, ultimately leading to a positive and streamlined treatment experience for patients.
Success could be visualized as the integration of standardized processes, training regimes, and the introduction of electronic workflows, with an emphasis on patient-centricity. Adopting these recommendations might contribute to meaningful adjustments in the radiation medicine landscape in West Africa, leading to operational improvements, enhanced patient care, and iterative progression.
Empowering Communities through Radiation Medicine Education and Engagement
In an effort to elevate public awareness about radiation medicine in West Africa, it is vital to forge partnerships with local communities, cancer survivors, media outlets, and healthcare professionals. Public campaigns should focus on addressing misconceptions and emphasizing the importance of early cancer detection and the potential benefits of radiation therapy. By collaborating with local influencers, traditional healers, spiritual leaders, and community health workers, the outreach can be extended, including to isolated regions.
In addition to treatment access, proactive public health strategies are vital for cancer prevention. Awareness-raising campaigns, educational initiatives in schools, and community training for self-examination skills are crucial for enhancing health literacy and promoting early detection. The dissemination of information regarding current national programs, policies, and plans for outreach is crucial. Sharing insights into telemedicine initiatives can support remote mentoring, e-visits, and oncology training for primary care physicians, which is essential in areas where traditional healthcare infrastructure may be lacking.
Accessibility and affordability of radiation therapy and medical imaging are essential, considering the challenges patients face in reaching hospitals. Addressing this issue requires the development of comprehensive support systems for patients in rural areas. Such systems ought to facilitate transportation, provide nearby accommodation options, and ensure food security during treatment. Alleviating these logistical obstacles is key to making life-saving radiation therapy accessible, regardless of distance or financial constraints.
In addition, identifying and implementing best practices for rural outreach will be key to increasing access and ensuring comprehensive care is within reach for all communities. Universal healthcare and insurance coverage may offer a solution for more equitable access. It is also beneficial to keep civil society, policymakers, and NGOs informed about the entire cancer care process, from prevention to treatment. With National Cancer Control Plans (NCCPs) overseen by the National Ministries of Health, there is potential for improved coordination in cancer care across various hospitals and communities. Enhancing communication channels between liaison officers, ministries, and hospitals is another aspect to consider.
Facilitating a seamless navigation path for patients, from the initial consultation to specialized care, is essential for ensuring timely interventions and improved health outcomes. By integrating these elements, it is possible to make strides in radiation medicine in West Africa.
Linking the Report to UN SDGs
The importance of the SDPU symposium and its subsequent recommendations is deeply intertwined with its alignment to the broader global agenda set by the UN SDGs. Any effort to enhance access to radiation medicine in West Africa is directly connected to several pivotal SDGs, highlighting the regional, global, and moral urgencies of this initiative. Specifically, the focus on radiation medicine seeks to address SDG 3, which aims to ensure healthy lives and promote well-being for everyone, by aiming to curtail mortality rates from non-communicable diseases, such as cancer, and bolstering the treatment and care of these diseases in the region. Additionally, by striving to diminish disparities in radiation medicine access, the initiative touches on SDG 10, which calls for a reduction in inequality both within and among countries. This not only levels the healthcare playing field within West Africa but also seeks to narrow the healthcare disparity between the Global North and Global South.
The efforts also resonate with the objectives of SDG 4 in ensuring inclusive and equitable quality education. This is seen in the initiatives for public education campaigns and capacity-building programs, emphasizing knowledge dissemination and continuous learning opportunities for healthcare workers and the public alike. The collaborative essence of the SDPU symposium, which amalgamated multiple stakeholders from diverse sectors, mirrors the spirit of partnership depicted by SDG 17, aiming to reinforce the means of executing and rejuvenating global partnerships for sustainable growth. Furthermore, the report’s stress on technological progression, upkeep of equipment, and infrastructural advancements ties seamlessly to SDG 9, which advocates for building resilient infrastructure and promoting inclusive, sustainable industrialization coupled with innovation.
In attempting to align the initiative and the suggestions of this report with the UN SDGs, stakeholders highlight the potential broader implications of their work and suggest a possible outline for international support and cooperation. This alignment might offer some advantages when seeking partnerships, funds, and endorsements.
Conclusion
In conclusion, the SDPU Symposium on Improving Access to Radiation Medicine in West Africa has provided crucial insights from among the community of stakeholders involved in radiation medicine with the region. Together, participants identified challenges that hinder the accessibility of radiation therapy services in the region. These challenges, such as inadequate equipment maintenance, workflow inefficiencies, and insufficient public education, have far-reaching implications for healthcare quality and patient outcomes. It is evident that addressing these issues is of utmost importance to bridge healthcare disparities, enhance healthcare quality, and positively impact economic and social development in West African countries.
The symposium has not only highlighted these contemporary challenges but also presented promising opportunities to overcome them. Collaborating with international partners to build capacity, embracing technological advancements, establishing public-private partnerships, creating new collaborations among health institutions within the region, and fostering innovation are potential pathways for progress. To achieve significant improvements, it is essential for stakeholders, including governments, healthcare institutions, private organizations, patient advocates, and international partners, to join forces in collective action towards implementing the recommended solutions.
This report outlines recommendations for further SDPU discussion, with a focus on standardized assessments, equipment procurement guidelines, and timely access to quality spare parts, all of which are integral for improvement, as demonstrated by the preparations for the Ghana symposium. Alongside this, targeted public education campaigns aim to dispel myths, build trust, and advocate for early cancer detection. The significance of engaging diverse stakeholders, enhancing patient support, and crafting a comprehensive radiation medicine model that aligns global standards with regional nuances cannot be understated. Furthermore, these assessments go beyond mere technical facets, delving into workforce conditions, clinical processes, and patient experiences, championing a holistic approach to ensuring quality care and operational excellence in the region.
Reflecting on this symposium’s goal, it is clear there is immense potential to harness the collective insights outlined in this report to enhance access to radiation medicine in West Africa. The enthusiasm of the experts to further develop and pursue these insights signifies their commitment to this initiative. Participants have also expressed an eagerness to reconvene in the future, ensuring that progress continues at a steady pace. Moreover, it is worth noting that certain concepts and issues have been earmarked for more in-depth discussions in subsequent gatherings. By exploring this collaborative approach, there’s potential to make progress towards the UN SDGs and increase accessibility to radiation medicine’s benefits in the region. While our collective efforts aim to improve healthcare accessibility and quality in West Africa, the journey ahead is long and will require continued collaboration to potentially pave a way towards a healthier future for its communities.
This report was composed by Dr. Liswi Mohammed of CRDF Global, with revision and editing by the SDPU team. For any questions about this report or the SDPU program, please reach out to sdpu@crdfglobal.org or by submitting a message via the Contact page form.
