Improving access to quality cancer management through sustainable capacity building “RAF 6050 PROJECT PRESENTATION” PRESENTER: E.N. NGIGI (Alternate coordinator) Coordinator Dr. Nyongesa 16th November 2017, NACOSTI HQs.

INTRODUCTION Cancer has remained among top most killer disease in Kenya. It ranks third as a cause of death in the country after infectious diseases and cardiovascular diseases. There are more cancer cases being reported in Kenya at present compared to the situation 10 years ago. It is estimated that the prevalence of cancer in Kenya stands at 38,000 and can cer deaths at 28000 Globocan 2012. The effort to develop radiotherapy infrastructure in both human and facility has its traceable history in 1960’s (KNH), with the Agency Technical Corporation partnership dated back in 1980’s. In KNH we are currently receiving approximately 60 new patients per week.

RAF 6050 OVERVIEW The access to quality cancer management implies availability of radiotherapy facility/infrastructure and qualified human resource. This RAF 6050, regional project started on January, 2017. This project was a merger of medical physics and Radiation oncology projects that had run independently before and later implemented and managed jointly for RAF 6044/6045. (Counterpart Dr. Nyongesa) The gap analysis in the design of this project; It focuses on quality of cancer patient management which is a multidisciplinary approach between radiation oncologists,(ROs) medical physicists,(MPs) Radiation Therapy Technologists (RTTs) and Oncology Nurses (ONs). Its is motivated by emergent of adoption of new technology and expansion of radiotherapy facilities in the region that require more clinically qualified personnel. Establishment of training programs locally/regionally that require harmonization for quality personnel with clinical training.

OBJECTIVES To enable facilitation of implementation of regional harmonised academic and clinical training programs for clinically qualified MPs and ROs and promote skills upgrade for all professionals including RTTs and ONs. To promote the current RDCs and identify potential new RDCs for training. To promote culture of audit and establishment of QA and clinical protocols in all departments. Strengthen regional professional groups which include FAMPO and AFROG in addressing research and development of professionalism in cancer management in African region.

ACTIVITIES Audit of RDCs and existing training centres for academic and clinical training. Evaluation of additional training centres to complement RDC’s Small equipment/educational material procurement to enhance teaching facilities in training institutions Develop a directory of regional experts to train/lecture in educational and training programmes Plan for regional training courses to address skills upgrade and modalities for effective CPD. i.e. RTCs/GFEs Implement expert missions, Task force meetings and RCM Train on how to implement the QA protocols

STATUS IN KENYA In the context of this regional project to Kenya as a member state, it is true that we are locally expanding radiotherapy services as well as establishing training programmes i.e. Six (6) radiotherapy private centers (CCK, AKUH, TNH, NRCC, TEXAS & AQUIRA) and one (1) public center (KNH) Two (2) public centers (KU &MTRH) under development. Currently, nine (9) Linacs, two (2) Co-60, three (3) Brachytherapy and one (1) Superficial radiotherapy Units in Kenya. RTT programme started in 2011 (KMTC/KNH & JKUAT/KNH) (KEN6019) RO (UON/KNH), MP(TUK/KNH) and ON (??/KNH) programmes are under establishment (KEN6021)

BUDGETED ACTIVITIES

Sub-Total for 2017 679,000 Year Input Component Fund Source Budget Estimate (Euros) 2017 2.2.1 EM (2 persons, 3 days) Expert Agency 6,000 2.3.1 2017 minor equipment for training and service. Procurement 50,000 3.1.1 Home based assignment (2 experts covering MP and RO, 10 days each) 20,000 3.5.1 Home based assignment for 4 experts (1 MP, 1RO, 1RTT, 1ON) for 10 days each 40,000 3.6.1 2 x regional workshop (1MP, 1RO with joint working sessions), 15 participants from each element, 4 days each) Meeting 120,000 3.7.1 TFM (3 participants, 5 days) 15,000 3.8.1 TFM (4 participants, 5 days) 4.2.3 RTC for 20 participants. Training Course 70,000 4.2.4 RTC for 20 participants 4.1.1 2 x TFM (1MP, 1RO, with joint working sessions, 5 days each) 60,000 4.2.9 Group fellowship for 5 participants, for 3 months Fellowship 81,000 5.1.1 TFM (3 participants, 5 days) 5.3.1 EM 2017 (2 per year, 2 experts, 3 days) 12,000 6.1.1 RTC train the trainers (5 days, 20 participants) 6.2.1 EM 2017 QUATRO audits of radiotherapy departments (2 per year) 30,000    Sub-Total for 2017 679,000

2018 6.2.2 EM 2018 QUATRO audits of radiotherapy departments (2 per year) Expert Agency 30,000 3.4.1 TFM (2 meeting 1MP, 1RO with joint working sessions, 5 days each) Meeting 60,000 5.3.2 EM 2018 (2 per year, 2 experts, 3 days) 12,000 5.2.1 RTC (20 participants, 5 days) Training Course 70,000 4.2.10 Group fellowship for 5 participants, for 3 months Fellowship 81,000 4.2.1 RTC Train the trainers (5 days, 20 participants) 4.2.5 RTC for 20 participants 2.1.1 EM( 3 persons, 5 days) 15,000 3.7.2 TFM (3 participants, 5 days) 3.2.1 TFM (2 meetings one for MP and one for RO with joint working sessions, 5 days for each) 2.2.2 EM (2 persons, 3 days) 6,000    Sub-Total for 2018 489,000

Sub-Total for 2019 494,000 Grand Total 1,662,000 2019 2.1.3 EM (3 persons, 5 days) Expert Agency 15,000 2.3.3 2019 minor equipment for training and service. Procurement 50,000 3.3.1 TFM (2 meeting 1MP, 1RO with joint working sessions, 5 days each) Meeting 60,000 2.3.2 2018 minor equipment for training and service. 2.1.2 EM( 3 persons, 5 days) 2.2.3 EM (2 persons, 3 days) 6,000 3.8.2 TFM (4 participants, 5 days) 20,000 4.2.6 RTC for 20 participants Training Course 70,000 4.2.7 RTC for 20 participants 5.3.3 EM 2019 (2 per year, 2 experts, 3 days) 12,000 5.1.2 TFM (3 participants, 5 days) 4.2.12 Group fellowship for 5 participants, for 3 months Fellowship 81,000 6.2.3 EM 2019 QUATRO audits of radiotherapy departments (2 per year) 30,000    Sub-Total for 2019 494,000 Grand Total 1,662,000

CONCLUSION

SUMMARY Relevance; the project focus is inline with Kenya’s national project agenda that involve establishment of training programmes and expansion of radiotherapy services (KEN 6020 & 6021) Achievement; this project and predecessor ones has broadly achieved its mandate on regional integration of oncology community, through; Shared experiences during RTC Development of regional curriculum Purchase of small QA equipment and books Challenges; shortfalls experienced includes low impact in dissemination of knowledge. i.e. Poor sharing of individual knowledge acquired at RTCs back at home Low Impact relating to technology transfer back home for a `5 days RTC Funding on facilitating RTC activities locally as member state Way forward At RCM it was proposed to include GFE trainings with center focus Also to have expanded expert missions to local situations and audits.

THANK YOU