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A combined imPACT mission organized jointly by PACT and the IAEA's Technical Cooperation (TC) department to assess and help develop cancer control capacity in the Republic of Madagascar took place 18-22 October 2007.
Although currently focusing its limited resources on the six PACT Model Demonstration Site (PMDS) countries, PACT also responds to requests from Member States for cancer control assistance by conducting imPACT missions when external financing becomes available. Following the IAEA 51st General Conference resolution on PACT urging support for all low income countries through imPACT reviews, and the specific funding received from the Governments of Monaco and France to support African countries, the PACT Programme Office was able to offer this service to Madagascar, with support from TC and with the participation of WHO/AFRO, IARC, INCTR and other organizations.
Madagascar is a French-speaking island of 18.5 million people situated off the south-east coast of Africa but ethnically linked to the south-west Indian Ocean region. Cancer figures for Madagascar suggest there are some 14,000 new cases each year but doctors at the country's sole cancer and radiotherapy department — located in the Hôpital Joseph Ravoahangy Andrianavalona (HJRA) in the capital Antananarivo — say they treat only 1500 new cases a year. Clearly, large numbers of Malagasy cancer patients are not getting the treatment they need.
To get a clearer picture of the situation and to help Madagascar formulate effective, workable cancer strategies, the PACT-led team met with Ministry of Health officials, doctors, nurses and other leading stakeholders. Minister of Health Dr. Jean Louis Robinson told the team that of all non-communicable diseases, cancer was the leading priority for his country. “Our Government is determined to address the growing cancer problem, because already there are more cases nationwide than our medical services can handle,” he said. Officials said a draft National Cancer Control Plan had already been formulated, but a serious stumbling block to its implementation was lack of resources. Madagascar's health system is heavily burdened with the fight against malaria, the country's number one killer.
Another major issue when dealing with the cancer crisis is the shortage of radiotherapy facilities. The HJRA cancer unit has 60 beds and is staffed with three radiation oncologists and one medical physicist who was trained in Morocco. But it has just one aging Chinese-built radiotherapy machine. France has agreed to donate a second machine and is currently working together with the IAEA to obtain a source. The mission learned that while funds are already in place to build the necessary bunker for the new machine, construction has not yet started. This means that Madagascar's radiotherapy shortage is unlikely to be relieved for at least another two to three years.
Nevertheless, raising cancer awareness and improving prevention is of prime importance. Mission members talked to officials and doctors about screening campaigns that are being initiated across the country and discussed ways of broadening and enhancing such efforts. At the same time, it was noted that palliative care hardly exists and, because of the expense, oral morphine is not freely available.
Madagascar is a poor nation. Life expectancy is under 60 years and total health expenditure per capita just $29. But, on a positive note, good primary health care is in place around the country as well as a reliable referral system. What is needed is to build on these strengths, while emphasizing that much more needs to be done. These issues will be addressed in the mission's recommendations.
The Madagascar mission demonstrates the kind of collaborative effort advocated by PACT in the fight against cancer and could act as a model for future imPACT services. In this instance, the Ministry of Health in Antananarivo asked the IAEA's Technical Cooperation (TC) department for support. TC, in turn, invited PACT to organize and coordinate the imPACT mission, while France supported the endeavour with experts and Monaco gave its financial backing.
To date, 18 countries in Africa and nearly 50 around the world have requested imPACT missions, to help assess cancer control capacity and develop strategies and resources to address their needs. To meet demand, PACT is examining the possibility of obtaining outside assistance to coordinate such missions using trusted experts, while continuing to participate as a leading partner.
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