Yangon

Diagnostic laboratories (clinical and pathology labs) and blood bank

• The assessors identified a lack of quality control and standard operational procedures in laboratories.
• The data also revealed a lack of clear Laboratory Information Management Systems (LIMS) and pathology reports were not standardised.
• Public laboratories faced shortages of major equipment and consumables.

Surgical care

• Yangon faced shortages of well-designed and equipped operating rooms for complex cancer surgery.
• There were no written surgery protocols for breast, cervix or colorectal cancers.

Medical oncology (adult and paediatric)

• There was a lack of adequate facilities to provide medical oncology services (including specialised equipment and IT development) in public hospitals.
• The supply of oncology medicines was erratic.

Medical imaging (radiology and nuclear medicine)

• Radiology equipment was limited and outdated in most public sector departments, and was not always covered by maintenance service contracts.
• Yangon lacked a Picture Archiving and Communication System (PACS) to ensure quality in the storage of images.

Palliative and supportive care

• Guidelines for palliative care in the city/region were lacking.
• Only one public hospital in the city had a palliative care clinic.

Radiotherapy

• Human resource shortages created long waiting times for teletherapy and brachytherapy in the public sector.
• Treatment at radiotherapy centres was not standardised.
• Radiotherapy quality assurance programmes were lacking at both institutional and city levels.

• Yangon’s organisational structure was inadequate for a city network of oncology services.
• There were no accreditation bodies for cancer services, and education and training programmes were lacking at a regional level.
• The budget for the recruitment and retention of qualified human resources for cancer care was inadequate.
• There was a lack of adequately trained staff for all imaging technologies, cancer surgery, radiation oncology and palliative care, as well as oncology-related staff (oncology doctors, nurses and pharmacists) and administrative supportive personnel, such as patient navigators and nurse managers.

• Discussion of treatment options by multidisciplinary teams was not standard practice.
• There was a lack of resource-appropriate guidelines for the management of oncology patients (including standardised treatment protocols).
• There was no electronic patient information system, or Population-Based Cancer Registry.
• Not every hospital treating cancer patients had an ethics committee.

• There was a lack of support for cancer patients and their families prior to, during and after treatment. Specifically, there was a lack of:
  • Patient and family education on diagnosis and treatment issues.
  • Patient and family psychosocial support and financial counselling for cancer survivors.
• Delays were noted in accessing cancer care, and treatment adherence was lacking.