Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up

Paul H. Park, Cyprien Shyirambere, Fred Kateera, Neil Gupta, Christian Rusangwa, Joia Mukherjee, Alex Coutinho, Leslie Lehmann, Lori Buswell, Lawrence N. Shulman, Joel M. Mubiligi, Francois Uwinkindi and Lisa R. Hirschhorn
Additional contact information
Paul H. Park: Partners in Health, Boston, MA 02199, USA
Cyprien Shyirambere: Inshuti Mu Buzima/Partners in Health, Rwinkwavu, Rwanda
Fred Kateera: Inshuti Mu Buzima/Partners in Health, Rwinkwavu, Rwanda
Neil Gupta: Partners in Health, Boston, MA 02199, USA
Christian Rusangwa: Inshuti Mu Buzima/Partners in Health, Rwinkwavu, Rwanda
Joia Mukherjee: Partners in Health, Boston, MA 02199, USA
Alex Coutinho: Inshuti Mu Buzima/Partners in Health, Rwinkwavu, Rwanda
Leslie Lehmann: Harvard Medical School, Boston, MA 02115, USA
Lori Buswell: Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA 02215, USA
Lawrence N. Shulman: Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
Joel M. Mubiligi: Inshuti Mu Buzima/Partners in Health, Rwinkwavu, Rwanda
Francois Uwinkindi: Rwanda Biomedical Centre, Division of Non-Communicable Diseases, Kigali, Rwanda
Lisa R. Hirschhorn: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA

Sustainability, 2021, vol. 13, issue 13, 1-13

Abstract: Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

Keywords: universal health care; cancer; implementation science; sub-Saharan Africa; Rwanda; universal health coverage; sustainable development goals (search for similar items in EconPapers)
JEL-codes: O13 Q Q0 Q2 Q3 Q5 Q56 (search for similar items in EconPapers)
Date: 2021
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