Kigali

Diagnostic laboratories (clinical and pathology labs) and blood bank

• The needs assessment identified a lack of infrastructure for basic histopathology and clinical laboratory services.
• The data also revealed limited availability of immunohistochemistry services.
• Quality control and operational procedures varied from one laboratory to the next.
• Information systems for cancer case reporting, including pathology reporting, were lacking.
• There was no external quality assurance programme in diagnostic laboratories.

Medical oncology (adult and paediatric)

• Facilities for medical oncology services in referral hospitals were inadequate.
• There was no essential medicines list tailored to the context of Kigali.
• There were no clear referral pathways or multidisciplinary management facilities for cancer patients.

Radiotherapy

• Availability of radiotherapy services was limited.

Medical imaging (radiology and nuclear medicine)

• The assessors found a lack of appropriate radiology equipment in referral and district hospitals.
• Radiology reports were often unstandardised.
• Quality control and quality assurance mechanisms for radiology departments were lacking.
• There was no available nuclear medicine department.

Palliative and supportive care

• There was no defined palliative care package for cancer patients. In fact palliative care was not included in the referral system.
• Essential palliative care was hampered by a lack of access to medicines.

• Cancer care services were fragmented due to a shortage of service and trained personnel (physicians and technologists).
• Both the referral and counter-referral system were inefficient.
• There was a time lag between the suspicion and diagnosis of cancer.
• The absence of formal continuing medical programmes and clinical research hindered capacity-building for medical specialists.

• Data for the planning, monitoring and evaluation of cancer care services and policies was not used systematically.
• There was no clear standardisation of diagnostic reporting.
• Multidisciplinary decision-making and treatment planning was fragmented.
• There were no resource-adapted guidelines for the management of common and curable cancer sites and corresponding treatment protocols.

• Patients’ access to the network of public cancer care services was limited.
• There was little awareness among the population, or among primary healthcare practitioners, of the early signs and symptoms of cancer.