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

BMC Cancer

Research Article

Neo M. Tapela¹  Mary Jue Xu²  Lydia E. Pace²  Caitlin Driscoll³  Ignace Nzayisenga⁴  Gedeon Ngoga⁴  JingJing Wang⁴  Cyprien Shyirambere⁴  Jean Bosco Bigirimana⁴  Frank R. Uwizeye⁴  Lawrence N. Shulman⁵  Bethany Hedt-Gauthier⁶  Peter C. Drobac⁶  Leslie Lehmann⁷  Tharcisse Mpunga⁸  Vedaste Hategekimana⁸  Denis Gilbert Umuhizi⁸  Clemence Muhayimana⁸  Egide Mpanumusingo⁸  Molly Moore⁹ 

[1] Botswana Ministry of Health, Gaborone, Botswana;Dana-Farber/Brigham & Women’s Cancer Center, Boston, USA;Harvard Medical School, Boston, USA;Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA;Harvard Medical School, Boston, USA;Icahn School of Medicine at Mount Sinai, New York, USA;Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda;Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda;Dana-Farber/Brigham & Women’s Cancer Center, Boston, USA;Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA;Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda;Dana-Farber/Brigham & Women’s Cancer Center, Boston, USA;Harvard Medical School, Boston, USA;Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda;Dana-Farber/Brigham & Women’s Cancer Center, Boston, USA;Harvard Medical School, Boston, USA;Boston Children’s Hospital, Boston, USA;Rwanda Ministry of Health, Kigali, Rwanda;University of Vermont College of Medicine, Burlington, USA;

关键词: Cancer;    Implementation;    Rwanda;    Resource-limited setting;    Capacity building;    Twinning;    Task-shifting;   

DOI  :  10.1186/s12885-016-2256-7

 received in 2015-10-25, accepted in 2016-03-08,  发布年份 2016

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Tapela et al. 2016