Pursuing equity in cancer care: implementation, challenges and preliminary findings of a public cancer referral center in rural Rwanda

Abstract

BackgroundCancer services are inaccessible in many low-income countries, and few published examples describe oncology programs within the public sector. In 2011, the Rwanda Ministry of Health (RMOH) established Butaro Cancer Center of Excellence (BCCOE) to expand cancer services nationally. In hopes of informing cancer care delivery in similar settings, we describe program-level experience implementing BCCOE, patient characteristics, and challenges encountered.MethodsButaro Cancer Center of Excellence was founded on diverse partnerships that emphasize capacity building. Services available include pathology-based diagnosis, basic imaging, chemotherapy, surgery, referral for radiotherapy, palliative care and socioeconomic access supports. Retrospective review of electronic medical records (EMR) of patients enrolled between July 1, 2012 and June 30, 2014 was conducted, supplemented by manual review of paper charts and programmatic records.ResultsIn the program’s first 2 years, 2326 patients presented for cancer-related care. Of these, 70.5 % were female, 4.3 % children, and 74.3 % on public health insurance. In the first year, 66.3 % (n = 1144) were diagnosed with cancer. Leading adult diagnoses were breast, cervical, and skin cancer. Among children, nephroblastoma, acute lymphoblastic leukemia, and Hodgkin lymphoma were predominant. As of June 30, 2013, 95 cancer patients had died. Challenges encountered include documentation gaps and staff shortages.ConclusionButaro Cancer Center of Excellence demonstrates that complex cancer care can be delivered in the most resource-constrained settings, accessible to vulnerable patients. Key attributes that have made BCCOE possible are: meaningful North–south partnerships, innovative task- and infrastructure-shifting, RMOH leadership, and an equity-driven agenda. Going forward, we will apply our experiences and lessons learned to further strengthen BCCOE, and employ the developed EMR system as a valuable platform to assess long-term clinical outcomes and improve care.

Haematological cancers in African children: progress and challenges

“…In 2012 Rwanda opened a cancer centre, primarily to serve the rural poor. This is a partnership between the Ministry of Health, academics and not-for-profit organisations (Tapela et al, 2016).…”

Impact of delayed care on surgical management of patients with gastric cancer in a low‐resource setting

“…Recognizing the vast differences in access to care for rural versus urban‐dwelling Rwandans, the BDH/BCCOE was established as a new center for quality cancer care within the country. In the facility’s first 2 years, over 2000 patients were treated for various cancers; among this population, gastric cancer was identified as the sixth most common solid, nonskin cancer tumor . In 2014, a 1‐year observational study at two Rwandan referral hospitals demonstrated that out of 82 total patients with GOO, over two‐thirds were diagnosed with gastric cancer .…”

Cervical cancer data and data systems in limited‐resource settings: Challenges and opportunities

“…Both systems continue to benefit from the collaborative approach through ongoing development by global communities of practice and support. These solutions have built‐in flexibility that enables incorporation of functionalities, data elements, and indicators for other programs, including cervical cancer . The capacity for automation of indicator data reporting from the patient level (OpenMRS) to the subnational and national levels (DHIS 2) reduces burden and enhances the quality and timely availability of data for monitoring, as seen in HIV/AIDS and other programs .…”

“…Processes such as probabilistic record linkage have also been successful in linking cervical cancer data across disparate systems to create ad hoc longitudinal patient records . These models can be evaluated to determine feasibility for local implementation, and capacity to serve cervical cancer data needs …”

“…A clear vision for short‐, medium‐, and long‐term progress and data needs is key to laying the foundation of systems that can evolve as programs advance . Advancement and innovative use of technologies provide exciting opportunities for piloting and implementing in research settings or Centers of Excellence—but a focus on simplicity should be maintained, with incremental implementation of what is practical, feasible, affordable, and necessary for the country and the program.…”