Cancer Control at the District Hospital Level in Sub-Saharan Africa: An Educational and Resource Needs Assessment of General Practitioners

Abstract

PURPOSE The WHO framework for early cancer diagnosis highlights the need to improve health care capacity among primary care providers. In Rwanda, general practitioners (GPs) at district hospitals (DHs) play key roles in diagnosing, initiating management, and referring suspected patients with cancer. We sought to ascertain educational and resource needs of GPs to provide a blueprint that can inform future early cancer diagnosis capacity–building efforts. METHODS We administered a cross-sectional survey study to GPs practicing in 42 Rwandan DHs to assess gaps in cancer-focused knowledge, skills, and resources, as well as delays in the referral process. Responses were aggregated and descriptive analysis was performed to identify trends. RESULTS Survey response rate was 76% (73 of 96 GPs). Most responders were 25 to 29 years of age (n = 64 [88%]) and 100% had been practicing between 3 and 12 months. Significant gaps in cancer knowledge and physical exam skills were identified—88% of respondents were comfortable performing breast exams, but less than 10 (15%) GPs reported confidence in performing pelvic exams. The main educational resource requested by responders (n = 59 [81%]) was algorithms to guide clinical decision-making. Gaps in resource availability were identified, with only 39% of responders reporting breast ultrasound availability and 5.8% reporting core needle biopsy availability in DHs. Radiology and pathology resources were limited, with 52 (71%) reporting no availability of pathology services at the DH level. CONCLUSION The current study reveals significant basic oncologic educational and resource gaps in Rwanda, such as physical examination skills and diagnostic tools. Capacity building for GPs in low- and middle-income countries should be a core component of national cancer control plans to improve accurate and timely diagnosis of cancer. Continuing professional development activities should address and focus on context-specific educational gaps, resource availability, and referral practice guidelines.

Provider Barriers and Facilitators of Breast Cancer Guideline-Concordant Therapy Delivery in Botswana: A Consolidated Framework for Implementation Research Analysis

“…Additionally, cancer‐specific knowledge was thought to be suboptimal among providers in nonspecialist peripheral hospitals. Similar gaps were reported in cancer‐specific knowledge among general practitioners at District Hospitals in Rwanda [ 38 ].…”

Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review

“…The paucity of infrastructure, equipment, medication and human resources needed for cancer care underpinned the barriers to receiving quality cancer care. 28 62 69 We noted a lack of availability or poor quality diagnostic equipment and treatment facilities were also challenges identified. 58 62 70 Other factors included demotivated and burnt-out staff and the lack of specialist training of staff in cancer.…”

“…An initial search identified 6391 articles of which 193 underwent full-text review (figure 2). Fifty-seven studies were included in our final sample and data extracted 23–78. The full data extraction output is included in the online supplemental appendix 2.…”

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