CHAI’s Feriha Ahmed with physicians and nurses from Ayder Mekele Hospital, after receiving training on breast cancer care at Black Lion Hospital.
Every year, 9.6 million people die of cancer globally. The vast majority—70 percent— live in low- and middle-income countries, where a person diagnosed with cancer is roughly 2.2 times more likely to die than in the United States.
Many of the cancers that are lethal in low- and middle-income countries are highly preventable, such as cervical cancer, or treatable, such as breast cancer. In 2018, in the United States, over 234,000 women developed breast cancer, while a little under 42,000 died of the disease. At the same time in Ethiopia, over 15,000 women developed breast cancer and an estimated 8,000 died. Over half of all women diagnosed with the disease succumbed, making it roughly 3 times more deadly for women living in Ethiopia than for women in the United States.
There are several reasons for this disparity. In Ethiopia, key barriers, such as shortages of trained workers and large distances between treatment facilities, hinder access to treatment. Indeed, there are currently only 13 oncologists and 18 pathologists for a population of over 100 million people. Until recently, there were no health facilities outside Addis Ababa offering cancer care, which led to over-saturation of the few treatment centers in Addis, long waiting times for treatment, and unbearable travel and accommodation costs for patients from outside the capital.
The government of Ethiopia is committed to addressing this disparity in cancer outcomes. Toward this goal, the government is constructing six new regional oncology centers, and procuring new technology including six new radiotherapy machines and about 1500 cryotherapy machines, which are used to treat pre-cancerous lesions on the cervix. In order to expand access and make treatment more equitable, the government is also subsidizing the procurement of lifesaving chemotherapy for all public facilities. The lowest income group patients can access these medicines at no cost. To address shortages of trained health workers, Ethiopia has a long-term plan to train more oncology specialists, nurses and pharmacists. Finally, the government is expanding breast cancer treatment to 11 hospitals across the country, while creating links to the national referral hospital for complex cases. The objective is to bring services closer to patients and significantly increase the number of patients receiving treatment.
Together, the government of Ethiopia, the Clinton Health Access Initiative (CHAI), the Norwegian Cancer Society (NCS) and the Norwegian Breast Cancer Association (NBCA), building on a collaboration between the government of Ethiopia, CHAI and the American Cancer Society (ACS), are supporting the Ethiopian Federal Ministry of Health to expand breast cancer care in six of the 11 designated hospitals. This partnership is focused on a) strengthening training in breast cancer treatment for clinicians through short courses, mentorships and supportive supervision; b) improving diagnostic capacity and pathological analysis for breast cancer and; c) strengthening management of the supply chain to ensure that high-quality medicines are available.
The effort to expand breast cancer care to hospitals outside of Addis Ababa is already bearing results. About 85 clinicians have been trained on breast cancer care in six regional hospitals. During the first half of 2018, these newly trained doctors and nurses treated over 250 patients across the six hospitals.
The success of this program is the result of strong government leadership alongside active NGO and private sector engagement. We hope it will serve as a model for other regions that face similar barriers to quality treatment and seek to bring services closer to patients.
This is just the beginning of Ethiopia’s efforts to decrease breast cancer mortality. With about 15,000 patients developing breast cancer each year, most of whom are not currently accessing services, there is more work to be done. On World Cancer Day, we celebrate the gains, but also recommit ourselves to finishing the job.
The American Cancer Society (ACS) is a nationwide, community-based voluntary health organization dedicated to eliminating cancer as a major health problem. ACS also works across Sub-Saharan Africa to strengthen access to cancer treatment, including chemotherapy, radiotherapy, surgery and pain relief, with a portfolio of collaborations with Ministries of Health and cancer centers.
