Problems and challenges in meeting the standards for effective Radiotherapy delivery in Nigeria

Abstract

PROBLEMS AND CHALLENGES IN MEETING THE STANDARDS FOR EFFECTIVE RADIOTHERAPY DELIVERY IN NIGERIA The World Health Organization (W.H.O) estimates that by 2020 incidents of cancer cases globally would hit 15.3 million; this is an increase of 51.4 % from the existing figure of 10.1 million recorded in the year 2000 and the estimated rise is largely based on an increase of 72.2 percent of new cancer cases detected in developing countries which could result in eventual deaths of about 6.3 million individuals within the next twenty years. The grim figures greatly highlight the need for curative, or at least, palliative measures to stem the growth of this foreseen cancerous catastrophe. To this end, some options are open which include the establishment of adequate treatment and palliative structures which are targeted towards early diagnosis and prevention in addition to encouraging radiotherapy enterprises within easy reach of patients as radiotherapy is a key facet of cancer management but the hitch therein is the high capital-intensive cost associated with establishing the infrastructure of such an investment coupled with the logistics associated human resource. Moreover, adoption and regulation of the high safety standards needed to keep such facilities running are crucial in efficiently running these facilities and stemming the projected rise of cancer in developing countries. In establishing a radiotherapy facility a host of factors are naturally to be considered the first of which is the clearance of a regulatory authority to ensure safety and protect user interest. Secondly, a prospective licensee is to present the regulatory authority with site plans like room layout drawings and information on building material concrete density to aid the authority in estimating and determining shielding requirements. Furthermore, an adequate number of staffs are to be available which must include specialized radiation safety officers, medical physicist, radiation therapy technologists among others. In addition, personal radiation dosimeters or monitoring badges are to be procured for all designated radiation workers for an agency accredited by the NNRA. Equipments for measuring radiation output and other dosimetric parameters are also necessary as well as obtaining an authorization from the NNRA by filing authorization forms NNRA/AUT/01 and 02 with a written radiation protection programme and all the necessary documents mentioned in the guideline for filling application for authorization. After all these procedures, installation of the equipments by an expert and commissioning of the facility by the NNRA follows after the authority has received an acceptance and quality control test. It is to be noted that no patient treatment can commence without obtaining a commissioning approval from the NNRA. Despite the rate of the good work the NNRA is performing, there are still some problems which plague radiation therapy practice in Nigeria. It is sad to note that the resolutions of the one day stakeholders meeting held in November 2005 concerning the state of radiotherapy practice in Nigeria has not been implemented. The resolutions of the meeting which pushed for better equipment, personnel practice, safety practices and funding to better the lot of cancer treatment in Nigeria has largely been unattended to. Thus, in addition to implementing the 2005 stakeholder’s resolution, the Authority should also be prepared by having a documented action plan on what it hopes to achieve in addition to conducting a nationwide audit by its senior staff to ascertain the level of non compliance, in addition to embarking on a nationwide enforcement action and conveying another stakeholders meeting to thrash out unresolved issues. Seminar presented by Timothy Akpa