Opportunities and Challenges in starting an Oncology Program at Aga Khan Hospital, Dar Es SalaamTanzania

Amyn Alidina, Medical Oncologist, Aga Khan Hospital, Dares Salaam

David MakumiEast African Regional Manager, AKUH Cancer Programs.

Regional Cancer Infrastructure.

Just who has what? Where?

How can everybody else access it

One Program, 2 Countries, 4 campuses Mombasa

Kisumu

Nairobi

Dar es Salaam

Prostate29%

Colorectal19%

Urinary bladder6%

Esophagus6%

lymphoma6%

Kaposis sarcoma

6%

Multiple myeloma

5%

liver3%

Pancreas5%

others14%

Male sites: AKH Dar jan –Sept 2014

Breast37%

Colon & rectul11%

Cervical9%

lym-phoma

8%

En-dometr

ium5%

Ovarian3%

leukemia

5%

Stomach3%

Pan-creas5%

Others15%

FEMALE SITES: AKH DAR JAN –SEPT 2014

10 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 to 800

5

10

15

20

25

30

AKUH Dar -Cancer Patients age Distribution

Standardizing oncology practice across 4 institutions in 2 countries.

How do we do it?

Prevention screening Diagnostics treatment Survivorship&Follow-up

Psychosocial support & Palliative Care

Cancer Control elements & Regional Cancer programs

Cancer information &

Awareness

Education & Research, Surveillance, Legislation & Policy

Mentorship & Education

• Knowledge transfer:

• Pharmacists• Nurses • Cancer Registry staff• Medical Officers

Mentored on Site Attachment with specific learning objectives.

Institutional and country specific adaptation of:

•Oncology Documentation tools•Oncology Policies & standards•Guidelines

• Once a week• 3 sites / 2 countries• Oncology topics of mutual

interest.• Cost effective model of

capacity building for oncology nurses.

• Initial investment in VC equipment

Nursing Education video conference

Shared tumor boards

Weekly

• General Tumor board

• Breast Cancer Tumor board

COMPUTERIZED PHYSICIAN ORDER ENTRY FOR ONCOLOGY DRUGS

Consultant Review/ Request

Doctor Prescribe Medication

Pharmacy Dispense

Medication

Nurse Administer Medication

Challenges

• Cost of medications.

• Regulatory issues for new products

• Training • Medical tourism

Opportunities

• Research• Education• Common regional specific guidelines • Product evaluation • Cancer registry

Conclusion

• Implementation of a new program is challenging at the best of times, implementation on a region-wide basis brings new challenges.

• Strong leadership participation is required to articulate a clear vision and ownership of the processes.

• All institutions have their own cultures and ways of doing business; this can be challenging when trying to standardize best practices.

• Do not re-invent the wheel: learn from others.

Asante Sana