Madagascar is facing a serious health challenge for years to come. About 18 000 new cancer cases and 13 000 cancer deaths are registered every year in the country. The outlook is quite grim: the figures are estimated to increase more than 50% in the next 10 years1. The reasons for these staggering figures are not uncommon to many other countries on the African continent; these include population growth, ageing and an increasing prevalence of risk factors for non-communicable diseases.
The Government is highly aware of the situation. "As a medical doctor, I know about patients and their suffering. I am personally committed to reforming and improving Madagascar's health system and to initiate a real change" said Dr. Mamy Lalatiana Andriamanarivo, the Minister of Public Health, underlining the commitment of the country's leadership.
In late 2014, the Government requested the IAEA to conduct an imPACT review to assess national capacities for comprehensive cancer control. The mission took place in August 2015 with a team of international experts in areas such as cancer control planning, registry, prevention and early detection, diagnosis, treatment and palliative care. "From the imPACT review, I expect tangible and pertinent expert recommendations to support and guide us in our fight against cancer", said the Minister when meeting the imPACT team on the first day of the mission.
The imPACT team visited a number of public and private hospitals in Antananarivo and Antsirabe, as well as primary care clinics and engaged with numerous national stakeholders involved in the fight against cancer, including NGOs. All these encounters reinforced the team's observations of a highly committed medical and nursing staff seeking to deliver the best possible cancer care in spite of constraints.
The imPACT team was deeply impressed by the dedication of the medical professionals encountered during the visits. "It is gratifying to see how sincerely they wish the national cancer control programme to succeed," said Dr. Namory Keita (Guinea), the mission's cancer control planning expert.
Preliminary findings of the imPACT team indicate that a significant part of Madagascar's rising cancer burden could be reduced through effective and timely preventive actions. In that context, experts and medical staff discussed the possibility of enhancing cervical cancer screening to detect and treat pre-cancerous lesions, a well-established intervention to reduce the cervical cancer burden.
The Mission team agreed with the Minister of Health's assessment that access to affordable cancer care is a key challenge in Madagascar. The Minister informed the experts about progress in establishing a public radiotherapy centre and confirmed his personal commitment. "I have launched the construction of a bunker that will house modern radiotherapy equipment at the University Hospital Centre Ampefiloha and I will follow its progress very closely."
The imPACT review is part of the IAEA's continued support to Madagascar in the area of cancer control. Further support includes capacity-building measures for radiation medicine and radiation protection as well as assistance in cancer control planning, cancer registry, palliative care and the mobilisation of resources.
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1 Source: Globocan 2012