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

Sustainability

Lawrence N. Shulman¹  Lori Buswell²  Lisa R. Hirschhorn³  Leslie Lehmann⁴  Joel M. Mubiligi⁵  Fred Kateera⁵  Alex Coutinho⁵  Cyprien Shyirambere⁵  Christian Rusangwa⁵  Joia Mukherjee⁶  Paul H. Park⁶  Neil Gupta⁶  Francois Uwinkindi⁷ 

[1] Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA;Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA 02215, USA;Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;Harvard Medical School, Boston, MA 02115, USA;Inshuti Mu Buzima/Partners in Health, Rwinkwavu, Rwanda;Partners in Health, Boston, MA 02199, USA;Rwanda Biomedical Centre, Division of Non-Communicable Diseases, Kigali, Rwanda;

关键词: universal health care;    cancer;    implementation science;    sub-Saharan Africa;    Rwanda;    universal health coverage;   

DOI  :  10.3390/su13137216

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown