Chad and Senegal are two of the eight pioneer countries of Rays of Hope, the IAEA initiative to increase access to radiotherapy for cancer patients in low- and middle-income countries. Nine months into the initiative, Chad is making preparations for its first cancer therapy centre in N’Djamena and plans to launch its National Cancer Control Plan (NCCP) in early 2023, while Senegal has recently completed its NCCP, detailing an ambitious national objective to scale-up cancer care outside Dakar, in particular increasing access in Diamniadio.

Improving access to cancer care in Senegal

Today, there are four operational linear accelerators — the machine most commonly used to deliver radiotherapy to cancer patients — in Senegal, each of which has a capacity to treat approximately 30 patients a day, under normal conditions. The country is also expanding its nuclear medicine services with a plan to serve other countries in the west Africa region. The IAEA has supported Senegal in the evolution of its programme on cancer care, including upgrading from 2D to 3D radiotherapy and brachytherapy in 2019, which has the benefit of producing more individualized patient treatment, better clinical outcomes and reduced side effects.

In May 2022, at an event marking a pivotal milestone for Senegal, more than 50 national professionals from hospitals, public administration and civil society participated in the official validation of the national NCCP for 2022-2025, alongside IAEA officials and international experts in cancer control.

“The development and adoption of this new NCCP allows the government of Senegal to identify the priorities for cancer prevention and control,” said Dr Babacar Gueye, Director of the Senegalese Ministry of Health’s Directorate for Disease Control. “In particular, this plan will guide us in allocating the necessary resources to reactivate the cancer registry and to advance the decentralisation of radiotherapy services.  

Furthermore, by defining the baseline and the targets for the next five years, we will be able to monitor and evaluate the progress of our capacity to scale-up the access to cancer diagnosis and treatment to the whole country.”

On World Cancer Day 2022, Rays of Hope was launched by IAEA Director General Rafael Mariano Grossi, joined by, among others, Senegal’s President and Chairperson of the African Union, Macky Sall, who has since made statements championing the initiative in his country, across the African region and most recently at the 77th Session of the United Nations General Assembly.

Through the Rays of Hope initiative, the IAEA has provided technical advice to reinforce the cancer control programmes in these participating countries, where the two most common cancers are breast cancer and cervix uteri, with the support of the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC).

Decentralizing cancer care in Chad

In 2020, following the development of a bankable document with IAEA assistance to describe their planned activities to potential donors, over €20 million was mobilised by the Kuwait Fund for Arab Economic Development in support of Chad’s cancer control activities. In particular, the funds will be used to construct the first public centre for the treatment and control of cancer in N’Djamena, the national capital.

“The Rays of Hope initiative provides a concrete step for our country towards a long-term investment strategy,” said Dr Fatima Haggar, National Coordinator of the Chadian Ministry of Public Health’s Programme on Cancer. “This perspective will allow the government to develop a set of milestones to be achieved during the next ten to fifteen years to ensure the whole population of Chad has equal access to diagnosis and treatment services.”

Chad’s NCCP for the 2022-2026 period includes the development of capacity building programmes in medical oncology, radiation oncology and surgical oncology for all categories of staff — including physicians, technologists, medical physicists and nurses — and the construction of the first cancer centre in Ndjamena region. The completion of the NCCP, along with the anticipated completion of the cancer centre in 2025, brings important progress and hope for cancer patients in Chad.

“As we all know, a stand-alone initiative cannot tackle the cancer burden,” Dr Haggar said. “We must ensure a comprehensive strategy to address the whole continuum of cancer, from prevention to palliative care. By establishing the first cancer centre in N’djamena and strengthening our information system, we want to promote the comprehensive care of cancer patients, ensure an effective referral system to the centre and the timely diagnosis and appropriate treatment of patients.”

Following the recommendations of an assessment of cancer control (imPACT Review) in Chad in 2012, the country has focused efforts on training in oncology for doctors, setting up a unit of paediatric care, while strengthening anatomical units and imaging equipment. Because there is no radiotherapy programme yet in Chad, a radiotherapy referral system facilitates the travel and treatment of patients to receive radiotherapy abroad, mainly in Cameroon, Egypt, France, Jordan, Sudan, Turkey and Tunisia. Instituting a national radiotherapy capability is precisely the area that Rays of Hope can help improve.

For Chad and Senegal, as well as other countries in need of increased access to radiotherapy for cancer patients, Rays of Hope is already starting to build on the IAEA’s strong history of support in healthcare where it most needed.