Challenges include the lack of awareness, finance and screening facilities, leading to late diagnosis and worse outcomes. Once diagnosed, there are not enough doctors or treatment facilities to serve the population: Dr Nestory Masalu, Head of Oncology at the Bugando Medical Centre, Mwanza, has seen patients travelling from as far as 500 km away for screening.

The four-year Tanzania Comprehensive Cancer Project (TCCP) began in the Dar es Salaam and Mwanza regions in 2018, working with 100 public primary healthcare facilities to strengthen oncology care and providing equipment, training, and public awareness and vaccination campaigns. A partnership between the Agence Française de Développement, the Government of Tanzania, the Bugando Medical Centre, the Ocean Road Cancer Institute, the Institut Curie and AKDN, the TCCP culminated in the creation of a new cancer centre in the Aga Khan Hospital, Dar es Salaam. This opened in May 2024 and is treating 100 patients a day, helping cover their costs as needed.

How is it changing the situation? Dr Harrison Chuwa, Head of Oncology at the Aga Khan Hospital, Dar es Salaam explains his biggest challenge: 85 percent of patients were seeking help at an advanced stage, when the five-year survival rate drops from 85 percent to only 30.

Addressing stigma

“This is partly because many believe that cancer is not a disease, but bad spirits, needing a witchdoctor,” says Dr Chuwa. “They may think that if you remove your breast, you are removing your spirit. There's also a belief that cancer is transmissible, so the spouse might worry that he or she will get the disease, leading to divorce. Thinking that cancer is a death sentence, they might decide to replace their spouse.”

The project has recruited and trained 400 community healthcare workers to encourage screening. “We've also trained our cancer survivors as ambassadors. They go out and provide their own testimonies, even showing their mastectomy scars, or hyperpigmentation from radiation, to show that this was years ago and they are still alive. They share pictures from when they were going through chemotherapy, saying ‘Look at me now, I am beautiful, I am relaxed.’ This goes a long way to change mindsets.

“There are civil society organisations embedded in the community who are engaged in raising awareness of cancer and persuading patients to come for hospital treatment. We give our knowledge and our time to support their campaigns.”

Putting patients at the centre

“Our hospital is a Joint Commission International accredited facility, which means we need to comply with patient and family education standards. The project supports the printing and development of materials to help patients understand their journey. The materials answer frequently asked questions about radiotherapy and chemotherapy, and what to expect.

“We go through a multidisciplinary tumour board for each patient, again supported by the project. There we develop a treatment plan, which we share with the patient so that they are aware of each and every step.

“We've established cancer survivorship groups. We meet quarterly and they select a topic that they want to understand, because we know it is not easy to assimilate back into the workplace or family after cancer treatment. They might have challenges swallowing, so we go through what foods to eat. If they have speech challenges, we have speech and occupational therapy. We encourage the survivors to come with their family and friends, who all see that cancer is not what they thought.”

Ensuring continuity

The TCCP treated 33,800 cancer patients – but what happened when it ended?

Over the last few months, the team has integrated their community interventions with the KfW COVID-19 vaccination project. An oncology team travels with the vaccination vans to screen men and women for cancers. And a new project phase is soon to begin.

“You get an opportunity to test interventions and to see if they work. If they do, you can scale them up in subsequent phases of the project. And this is exactly what happened here. We’ve just signed an agreement to continue with the second phase, the East Africa Comprehensive Cancer Project (EACCP), focused on women and scaled up to four more regions in Tanzania and also working in Kenya.”

One long-term outcome will be the results of the research still underway.

“You cannot have good clinical outcomes without having good research,” says Dr Chuwa. “You need data on the geographical distribution of cancer in the country, whether there are more predominantly female or male cancers, or what proportion are infection related.

“What are the barriers? Why are people reluctant to go for screening, what stops them going for diagnosis, and what prevents them from starting treatment? Is it financial, to do with their location, or from myths that they believe?”

The results will emerge over the next few years. In the next phase, researchers will also collaborate with the Aga Khan University’s Clinical Research Unit in Kenya. Here the focus is on novel therapies in the management of cancer in African populations, where differing genetics mean that drugs developed through research in the West may not have the same outcomes, and tailored research is needed.

Another long-term benefit of the project is the expansion in trained oncology professionals. More than 460 healthcare professionals have learned specialities such as pathology, radiology, medical oncology, palliative care – and even survivorship programmes and journalism.

The newly announced EACCP will similarly be a multi-partner collaboration. The French Ambassador to Tanzania, Her Excellency Anne Sophie Avé, describes “the remarkable partnership between France and the Aga Khan Development Network” as “a shining example of how international cooperation can drive transformative progress in health care”.