As published by O’Neil et. al (2017), the majority of individuals diagnosed with breast cancer in Rwanda present with advanced and metastatic disease and 14% of patients have been found to be lost to follow up. As the country continues to develop and epidemiology shifts, Rwandans are living longer and healthier lives. Through local and international partnerships, significant advancements have been made in cancer prevention, diagnosis as well as treatment and care. Despite this, there is concern that as options for treatment and care are provided by different hospitals, many patients are lost to follow-up due to the need to navigate between facilities. In response to this, Rwanda’s Ministry of Health (MOH), through the Rwanda Biomedical Centre and in collaboration with Rwanda Palliative Care and Hospice Organisation (RPCHO), intend to develop an innovative, cross-cutting breast cancer care coordination system paying particular attention to the most high-risk, advanced stage breast cancer patients.
The Rwanda Biomedical Centre promotes high quality, affordable, and sustainable health care services to the population through the delivery of evidence-based interventions. RPCHO is a multidisciplinary, non-governmental organisation whose aim is to promote access to high-quality palliative care for all those living in Rwanda. Together, these organisations are partnering to implement a new SPARC project aiming at improving the coordination of care in the country.
“This grant means a lot to me and my organisation; it will complement ongoing efforts towards improving and standardising the care provided to patients with advanced breast cancer. We are also anticipating that lessons learnt on the national care model for breast cancer patients will also be applied to other cancer diseases at large.”
In 2019, RPCHO received a SPARC MBC Challenge grant to improve the national model of care for breast cancer in Rwanda, in partnership with the Rwanda Biomedical Centre. This project will see the creation of a national breast cancer care coordination system that will harmonise care across Rwanda’s five health facilities where breast cancer patients are treated.
A working group has been established, composed of key clinicians from each of the five cancer hospitals in Rwanda, representatives from Rwanda Biomedical Centre and RPCHO, representatives from the Ministry of Health, a representative from a breast cancer survivors association, and the Director of Oncology from the organisation, ‘Partners in Health’. The group will meet on a quarterly basis to monitor the implementation of the project and to ensure good coordination of and centralisation of information regarding care providers, services and patients.
At each of the five cancer referral facilities namely: Butaro Cancer Center of Excellence, Kigali University Teaching Hospital, Rwanda Military Hospital, King Faisal Hospital and Butare University Teaching Hospital, a breast cancer care nurse will be identified as a focal person to help in organising the care of patients with the support of key clinicians at the hospital. On top of the focal points persons, additional breast cancer coordinators within each of these hospitals will be trained to improve patient coordination.
Electronic medical records, including a unique identifier for each patient, are being implemented in the different hospitals to help harmonise the care provided to patients as well as enable the sharing of information between clinicians treating these individuals with breast cancer. Based on the electronic medical records of the different hospitals involved in the project, this project will also help to develop a breast cancer registry within the Ministry of Health.
A breast cancer care coordinator who will serve as patient navigator will be hired to connect all participating hospitals.
The national breast cancer care coordination system is specifically designed to be a low-cost intervention, which can be integrated into Rwanda’s existing health system and human resource structure. At the end of the 12-month implementation phase, the system is intended to be fully integrated into Rwandan Ministry of Health’s non-communicable diseases division. A breast cancer registry will be created using the software of Rwanda’s National Cancer Registry and will help to mitigate barriers to care. Furthermore, Rwanda Biomedical Centre will train five breast cancer focal points in each of the hospitals, and 25 breast cancer care coordinators.
Following Rwandan Ministry of Health standard evaluation protocols for programmes and a mixed methods approach, an external evaluator will assess the activities, deliverables and impact of the project. Based upon this review, the new care system could potentially become a national cancer care model for other cancers to be implemented at a national level.
Through this project, it is anticipated that the number of advanced breast cancer patients who are lost-to-follow-up will decrease and that their quality of life will be improved. Ultimately, the ambition is that this new system will contribute to increase the survival of breast cancer patients.
Organisation’s website: Rwanda Biomedical Center
 O’Neil DS et al. Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures. Journal of Global Oncology 2019 :5, 1-16.
(Information from the project description and context is compiled from the SPARC reports)