Expanding breast cancer care across Ethiopia

During Breast Cancer Awareness Month, it is important to remember that about 60 percent of breast cancer cases occur in low- and middle-income countries, where breast cancer is roughly 64 percent more deadly for women due to challenges in accessing quality treatment[1].

These challenges are due to cancer care being provided in only a small number of specialized centers, which may be unaffordable or impossible for women to reach.

Nurse training on management of breast cancer patients, Adama, October 2019

In Ethiopia, breast cancer is the leading cause of cancer mortality, with over 8,000 deaths each year. Under the leadership of the Ethiopian Ministry of Health, CHAI has supported a new approach  to make quality breast cancer care available to patients across the country. To do this, we have partnered with the American Cancer Society (ACS) and the Norwegian Pink Ribbon Campaign.

In 2016, there were only two hospitals in the country that could treat breast cancer. Both of them were in the capital, Addis Ababa — hundreds of miles away from many patients. Ethiopia also faced a severe shortage of health workers, with only 16 oncologists for a population of 100 million people. Not only was it difficult for patients to access treatment, but the few who did faced long waittimes for diagnosis and treatment. As they waited, potentially curable tumors progressed to advanced stages.

Map showing hospital expansion in Ethiopia.

In 2018, CHAI began supporting the Federal Ministry of Health to expand breast cancer treatment to six regional hospitals.

Our work focused on 1) training non-specialist health workers (e.g., general physicians, surgeons, and nurses) to diagnose and treat breast cancer patients, as well as providing ongoing clinical mentorship and supportive supervision, 2) training and supporting laboratory staffwith diagnosis and pathological analysis, and 3) providing training and technical assistance to central medical store and hospital pharmacists to strengthen supply chain management.

Through this model of care, we sought to demonstrate that with appropriate support, regional hospitals could provide patients with high quality, focused care and better access.

Our program has already helped address the access challenges patients face: shortening diagnostic turnaround times, improving quality of care, and increasing  availability and affordability of medicines.

As a result of this work:

  • Average waiting times to start treatment after diagnosis dropped from four months at the central hospitals in Addis Ababa to one week at most at the regional hospitals — a 90 percent reduction.
  • Turnaround times for breast cancer diagnosis with fine needle aspiration (FNA) biopsy went from 10 days to three days on average at regional hospitals, thanks to laboratory technician training.
  • Onsite clinical mentorships have been provided throughout the program, with a shift to digital mentoring once Covid-19 affected ability to safely travel within Ethiopia.
  • A CHAI-supported national forecast also helped the government double the cancer program’s procurement budget between 2016 and 2018. As a result, the availability of essential chemotherapies at regional hospitals has substantially increased.
  • CHAI expanded this program from the six initial regional hospitals – we are now supporting eight hospitals

This holistic approach to the national cancer program included reimagining how diagnostics, clinical care, and supply chain management were delivered to reach patients where they are.

This made treatment for the highest burden cancer in the country accessible and affordable to those who needed it most. This program can serve as a model for other countries seeking to expand the reach of cancer services despite significant human resource constraints.

[1] WHO-IARC Cancer Today 2018 data. In 2018, 824,000 women developed breast cancer in high-income countries (HICs) and 179,000 women died from breast cancer, while in low-and middle-income countries (LMICs), 1,250,000 women developed breast cancer and 445,000 women died from it.