How can industrial innovation support better access to cancer care in Africa?

Image: Professor Fortunata Songora Makene (left) and Dr Ntuli Kapologwe (right) celebrate the official launch of the book Cancer Care in Pandemic Times: Building Inclusive Local Health Security in Africa and India at Economic and Social Research Foundation, Dar es Salaam, Tanzania, on the 20th February 2025. 

Together with our colleagues in East Africa, at the Kenya Medical Research Institute (Nairobi, Kenya) and the Economic and Social Research Foundation (Dar es Salaam, Tanzania), as well as India and UK-based partners, we have been researching ways to improve access to cancer care in African countries since 2018, through our ESRC-funded project, Innovation for Cancer Care in Africa (ICCA). 

Cancer and other non-communicable diseases pose a growing problem for health systems in Africa. In both Kenya and Tanzania, the large majority of cancer patients are diagnosed at a late stage, when only palliative care is possible. This is often attributed to ‘late presentation’ of patients, explained primarily with reference to patient behaviour and knowledge and as something to be addressed through education and awareness campaigns. However, our interviews with healthcare workers, government officials and policymakers, carers, and over 450 patients, showed us the limitations of this framing and the importance of wider systemic factors. Patients we interviewed experienced their longest delays prior to diagnosis after they had sought help at a medical facility. Reasons for delay included weak referral systems and the need to make expensive journeys over long distances to access diagnostic pathology and imaging. The prohibitive costs of seeking care mean many are never formally diagnosed. As one doctor, who regularly referred patients needing a biopsy to facilities hundreds of kilometres away, explained, ‘you know they will not go and you just write the referral.’ The costs of care and of travel to obtain it mean that experiences of delay are shaped by wider socio-economic inequalities. 

Indeed, the experience of seeking care often feels like navigating a maze. Patients shared experiences of misdiagnosis, unclear referral pathways, poor communication, and reliance on personal initiative and perseverance. Patients incurred significant costs throughout their care journey, when paying for services out of pocket, buying medicines or equipment that were out of stock, and paying for travel and accommodation to access care. At the same time, having cancer significantly impacted people’s ability to pursue their livelihoods. Many must ask friends and family for financial support, sell assets such as land, or sacrifice other aspirations, such as starting a business or sending children to school or university. In this way, cancer can threaten important social relationships for cancer patients and their loved ones, and undermines their ability to undertake valued social roles and responsibilities. These broader social impacts of cancer were very evident to patients, carers and healthcare workers, who discussed not only the physical pain of cancer, but also the ‘social pain’ it causes. 

These challenges are compounded by reliance on expensive imported medicines and other commodities. Therefore, as well as investigating factors within the health system, we explored the potential for local industrial innovation to support improved access to healthcare. Building on our previous research on Making Medicines in Africa, we argued for greater attention to the role of local manufacturing in supporting health systems in low and middle income countries. Through interviews with a diverse range of manufacturers, distributors, and key policy makers we explored opportunities to address the un-met need for cancer-related products through local production.  We considered how dynamics such as changes in procurement and regulatory policy, market consolidation, technology transfer, and rising ambition across the sector could enable more local production of products such as oncology drugs and biologics, intravenous solutions, and commodities such as colostomy bags. 

The risks of relying on imports were starkly demonstrated by the Covid-19 pandemic, which hugely disrupted global supply chains for pharmaceuticals and related products. In both Kenya and Tanzania, the crisis put industrial-health links high on the agenda for politicians and others and prompted new imaginings of what was possible. Some ICCA team members were directly involved in policy and manufacturing innovations aimed at meeting local health needs and lessons learned during the pandemic informed our open access book, Cancer care in pandemic times: building inclusive local health security in Africa and India, published in 2024. In this context, we were excited to have the opportunity to use OSC funding to share our research with   important stakeholders in Kenya and Tanzania at high profile book launch events in Nairobi and Dar es Salaam. 

The timeliness of this work was evident in the feedback from our esteemed invited speakers, which included, in Kenya, Dr Elias Melly, CEO of National Cancer Institute of Kenya, David Makumi, CEO of Faraja Cancer Support, and Dr Tom Menge, Head of the Directorate of Health Products and Technologies at the Ministry of Health. In Tanzania, we were honoured to host Professor Mohamed Janabi, Advisor on Health Policy and Nutrition to the President of Tanzania and Executive Director of Muhimbili National Hospital who was recently nominated as next director of WHO Africa Region , and Dr Ntuli Kapologwe, Director General of East, Central and Southern Africa Health Community (ECSA-HC), who, as he formally launched the book, pledged to be an ambassador for the research across the region. The media coverage we received in Tanzania’s major daily English and Swahili daily newspapers as well as in news bulletins from the public broadcaster is also testament to the huge social impact of cancer in East Africa, and the urgent need to improve access to care. 

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